Patient Modesty: Volume 44
It has become clear from reading all the responses to this thread "Patient Modesty" that the issue of physical modesty in the context of medical care is not gender specific. Patients of both genders need attention by the healthcare providers to their modesty concerns. And yet, it appears in many situations, this attention is not being applied to that patient and because of resource differences, particularly with regard to the male patient. In addition, perhaps unrecognized to many of us, and as brought to our attention by the "stressed student" (SS) in the previous 2 Volumes even medical students may be aware or personally concerned about how and what they are being taught regarding sensitive genital and rectal examinations. Now.. continuing on with the discussion we will begin Volume 44. ..Maurice.
Graphic: Photograph of bronze Auguste Rodin's "Burghers of Calais-Pierre de Wissant" taken by your moderator 8-13-2011 at the Norton Simon Museum, Pasadena, CA
NOTICE: AS OF TODAY NOVEMBER 8, 2011 "PATIENT MODESTY: VOLUME 44" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 45
posted by Maurice Bernstein, M.D. @ 10:11:00 AM
154 comments
154 Comments:
SS the tests are required by the government in the case of the DOT physicals and the insurance company in the case of our insurance offering. I have no influence on either.
Dr Bernstein, I was curious, often it seems practices are SOP from the past and no one questions them. Hernia exams for boys in sports, requiring patients to be naked with just those ridiculous gowns for procedures such as wrist, shoulder, or carerat surgeries though the justification vs the risk is so miniscule it seems unwarrented other than its always been done that way. Can you shed any light on why women are subjected to pelvic exams for birth control etc., not saying they are or not valid, just curious as to the possiblity that these exams are sop's from the past that no one questions anymore, they just do them....alan
What you describe could very well be "standard operating procedures" carried on from the past with no strict evidence based investigations to support their continued practice. I can't fully deny that some could be interpreted as being tainted with physician monetary interest. It's time that the chaff of the past be separated from the wheat. ..Maurice.
Visitor mmodest wrote the following to Volume 3 which, of course, has been long time closed to commentary. I am publishing here on Volume 44. ..Maurice.
"First let me say I had my testicle ultrasound by a female and two nurses and my urology Dr stick a scope in to see my prostate.Did I feel uncomfortable?Yes but not embarrassed.So here's my story .I needed shoulder surgery(first time ever)so I scheduled it.I arrived at the hospital and laid on the bed.A nurse came in and I explained I was very nervous.The anesthesiologist came in also.Explained I wanted to see the Dr because I wanted to talk to him.The anesthesiologist said I'll give you a shot to relax you.Next thing I wake up from surgery so angry I wanted to murder them.I felt like I was raped.I was mostly pissed because I was in a vulnerable state and didn't meet the staff and explained was about to take place and know if I knew anybody participating.I need another surgery but Im apprehensive.Really didn't like the way I was treated.Can patients ask medical staff to be excluded if they dont feel comfortable with them and if so do they come back in after being put under?"
May I make a suggestion based on what I see is happening with some of my long term visitors to this thread on Patient Modesty? Perhaps, it would be appropriate to take a break away from the yet unsolved issues written about here and go off to one or more of my other currently over 840 topic threads. There you can free yourself of modesty concern for a while and indulge in some different topic for which you can contribute.
You may go away to these other locations on my blog but when you are refreshed you can make a return and be assured that this Modesty thread will still be here awaiting your further comments. ..Maurice.
Take a look at this dialogue from the UK!
http://community.macmillan.org.uk/groups/prostate-cancer/forum/p/40103/449944.aspx#449944
You may want to go to the page just before that page in order to read the beginning of the discussion (argument). ..Maurice.
That's an interesting thread. If you read it from the beginning you get the whole context. But still -- what we havehere, it seems to me, is
first, a poster who is inserts the gender-neutral, modesty issues into a discussion that isn't directly about that. The poster is trying to change the direction of the discussion.
second, that poster runs into a group of men who are comfortable with same gender care -- or at least have the macho, grin and bear it attitude.
third, that poster then becomes quite aggressive about his position.
forth, the other men don't accept that there may be different ways of viewing the subject. There are only real "men" like themselves or "wimps" like the poster.
When confronted with that point of view -- the web is not the best place for a discussion. One must use different strategies, lines of argument. The fact that they are comfortable with and/or accepting of same gender care is their right. That fact that they see that position as the only position, is something else. One must accept that you're not going to change any minds. That's just the way they think.
The focus of the discussion isn't really about modesty and gender-neutrality. It's about tolerance of other opinions, world world views, feelings.
Doug/MER
I have posted a new article on our blog, this one about privacy and reporters in locker rooms.
Take a look.
Sorry for taking sooo long to answer, but there were problems with the Internet connection. By "Third world" I mean non-industrialized countries, with big cultural & financial gaps between the poor and the more affluent, although the middle classes are somewhat better educated than the few rich.
You may be interested to read an article by a male medical student from McGill University Medical School regarding gender issues in Ob-Gyn particularly with regard to the role of the male medical student and male physician in relation to that specialty. ..Maurice.
Sorry but it is hard for me to believe a lot of the reasoning behind this male student's article. I am speaking from experience: I, along with all my female friends, would definitely go to a female gyn if the need to see one existed. And we are not young people but are middle-aged. I still do not buy that argument that women get used to having these exams so they are more likely to accept male physicians as time goes by. (Maybe some do, but not all or maybe not most.) Also, one has to take into consideration that they are polling women that already are presenting for these exams and not going into the general population, including those who avoid doctors. I think that if men do want to go into this speciality they should not necessarily be discouraged because there, of course, will always be women who do not mind seeing a male. But I also do not see it being a big problem that the field is dominated by females because those who would accept a male physician would probably not have a problem with either gender. I would like to see if this same medical student thinks more women should be encouraged to go into urology, where the majority of patients are probably male. The gender premise would have to work both ways, in my opinion. But I suppose it all boils down to patients having a choice, so ideally there should be adequate numbers of physicians in all specialities of both genders. So, medical schools should not just encourage men to go into ob/gyn but should present each speciality in equal light to hopefully get a balanced gender mix in all areas. Jean
Dr. Bernstein,
Personally, I find Balayla's article both biased and self serving.
He chooses to cite Johnson as a basis that women have no significant preference for female gyns, while completely ignoring studies such as those by Plunkett et al, Navizedeh et al, and Schmittdiel et al, to name a few, that indicate a significant number of women (53%-61%) do have a preference for a female gyn provider.
Further, his opinion, based on anecdotal information, that male gyns spend more time with the patient and are more empathetic is not supported by the facts. A study by Dulmen & Bensing based on detailed analysis of actual patient encounters, determined that female gyns spent more time per patient encounter, more time on the exam, had more verbal exchanges with the patient and made fewer instrumental and more effective statements than their male counterparts.
And it's not just gyn. A study by Menee et al, concluded that the significant preference by female patients for a same gender physician to perform a colonoscopy is a significant barrier to colon cancer screening for females.
IMHO, his article is intellectually flawed, as he selectively cites references to support his opinion, while completely ignoring numerous valid studies that provide contradictory information.
Like I said earlier, biased & self serving - it's nothing more than an opinion piece, not valid research.
Interesting article Dr. B, but he's clearly trying to justify male OB-Gyn's. He's correct about the age differential. Younger women prefer female Ob-Gyn's in much greater percentages than older women.
He doesn't talk at all about the prejudice against male students and Ob-Gyn's which has been amply documented in many blogs. It doesn't happen everywhere but some programs discourage men from going into Ob-Gyn. In other schools male students find it difficult to get practice doing female exams, not because of school policy but often because of nurse attitudes in clinics.
This may be little different than the obstacles women find going into urology for example. But I wouldn't be surprised if in 10 years Ob-Gyn's are 90% women; they already are in some training programs.
My grandmother, who was married to a doctor, once told me this about male ob/gyns: "It is simply not natural, dear, for a man to want to spend his life with his head between a woman's legs." I agree. BTW, why aren't there any women proctologists or urologists? Anne
Actually there are female proctologists (now called gastroenterologists). I know of several in the large city nearby, but the profession is still predominately male. Same with urology: there are a few females in my area but mostly males. So it is possible to find a provider in these fields of either sex.
Also, back to the point about male ob/gyns. If younger women overwhelmingly prefer females, then it would stand to reason that they would be used to them and not want males as the years go by. So, current male medical students would face a larger obstacle in the speciality in years to come with this new population of patients. Let's face it: there has to be a big reason behind the current shift towards females in not only in the ob/gyn field but also in mammography. And I think that reason is that women feel more comfortable having same sex providers for these intimate areas. Jean
"Let's face it: there has to be a big reason behind the current shift towards females in not only in the ob/gyn field but also in mammography. And I think that reason is that women feel more comfortable having same sex providers for these intimate areas. Jean"
Yes, Jean. But is that the controlling factor? How patients "feel" -- I suggest -- is not the controlling factor. Here are some possible controlling factors for the above.
-- Culturally, women's feelings in this area is a more sensitive area and more likely to be addressed than men's feelings.
-- Women speak up and make their preferences known more than men.
-- The medical industry recognizes that women make the family medical decisions and market to them, and thus market to their feelings.
-- After years of being left out, women are now becoming a force in the medical field. In some areas, as we've suggested, they are still a minority. In other areas, they dominate.
-- Since the 1960's, Federal law has recognized women as a protected minority, and thus, the culture is more sensitive to their requirements. Not accommodating a woman medically is more likely to result in a lawsuit than not accommodating a man.
There are probably other reasons, too. What I'm saying is that to go from how patients "feel" to what they "get" in medicine is not a direct line -- but a complicated, political/sociological/economic route.
Doug/MER
a couple thoughts come to mind, while Dr's gender can be chosen by patients, and therefore eventually staffing evolves in that direction, we have not choice in nurses and that remains, unlike OBGYN Dr's virtually unchanged at 90% pluss female.
Second, to Doug's point, one of the major hospitals in Indianapolis has multiple billboards and numerous ad's running in the media for a free advice line 4-her. It adverstises free advice for women by a female NP. I went to their web site, no link for men so I went to contact us and asked where I could access the free advice line for men, I recived a simple one line response. We do not have an advice line for males.,,,kind of says it all as to the attitude of medical providers for men doesn't it? kind of ironic during prostate awareness month...oh didn't know that? that also is not a surprise.....alan
Doug, While I accept what you say, it's all about money. The foundation of same gender care for mammography lies in the dollars. Women refused male workers, plus, these male workers if accepted required a chaperone. All of it boils down to $$$$. When patients refuse a certain gender in droves, does it make sense to hire and try to bully either gender into medical care that they don't want. And...whose fault is it that the men don't do anything abut their situation. If they felt as strongly as the women and refused to cooperate, things would change for them too. I am in total support of male rights equal to female rights. It's the medical profession that must put their ego on a back burner and put "to do no harm" on the front burner.
Belinda
Belinda -- We have no argument. I agree with you. Until men speak up, things will really not change. And until we really know who men as a group feel about this, we're shooting in the dark. Maybe the number of men who are homophobic or just to "macho" to ever speak up or really don't care one way or the other -- is larger than we think. But men, like women, need to realize that they're paying and their dollars count and they do have clout.
Doug/MER
Belinda
Are you suggesting there are no "dollars in the
treatment of prostate cancer." Women never refused
male workers in mammography. Female patients never
held up signs outside of hospitals detesting male
Mammographers.
The decisions were made on the inside as it was
the directors of radiology departments and administrators
who kept men from cross-training into mammography.
When female nurses needed a mammogram at the
hospital where they worked, they didn't want some low life
male x-ray tech cross-trained mammographer looking at
their breasts.
Yet, these same concerns for male patients are
non existent. Too further read about this double standard
look at the thread on all nurses, men in L&D.
PT
PT, When men start refusing the female care for their intimate needs, they will have to reform the system to make money. There is research out there that says that colonoscopy is not being performed for this very reason.
If the medical community wants to see real growth in cooperating prostate exams in the dollar department, they can do it sooner offering to accommodate the men and the men need to speak up
belinda
Doug: I agree that how a patient "feels" and what they get is not a direct line. A lot of other factors come into play, unfortuneately many having to do with money. But my comments were a knee-jerk response to the male medical student's bemoaning the lack of males going into or being encouraged to go into the ob/gyn field. Another factor that may explain why that field is beginning to be dominated by females is that once medicine opened up to women, a lot of them may have chosen that area to specialize in because they, as women, can relate to those specific issues. They may have a certain "sympatico" in other words.
On a little different subject: I also noted in the male medical student's piece that he stated a specific interest in caring for women's health. What I don't understand is the constant emphasis on ob/gyn (and especially, gynecology) being the basis for women's health care. I understand that a large percentage of women will give birth and require services for that but I do not understand otherwise why there is a constant need to survey women't sexual organs, like they are a disease waiting to happen. A doctor can still be involved in women's health care without being a gynecologist! I personally don't see the need for a gyn to be a woman's primary doctor. Women have a greater incidence of things such as hypertension, heart disease, diabetes and lung cancer than they do gynelogical conditions/cancers. But it seems that is the area that doctors are always focused on. There is quite a bit of evidence out there that pelvic exams, pap smears and hysterectomies are of questionable value, especially in asymptomatic women and/or done too frequently with little or no informed consent. Just my opinion. Jean
Dr. Bernstein:
"SS, do you have any information regarding how your views expressed here (specifically with regard to invasive rectal/genital examinations) match those of other countries or other cultures for example, in oriental or in Muslim cultures."
There are articles about Muslim male students refusing to examine female patients. When I showed one article to the OBGYN Dean, he commented he had read about it all before.
While in medical school, I roomed with two Muslim sisters. One was an internal medicine resident, and her older sister was a business entrepreneur. The resident told me she was okay performing exams. Although as a patient, she would never see male gynecologists.
My resident roommate also told me she knew one classmate in medical school who had serious issues performing these exams, although I do not know if it was because of her Muslim background.
My entrepreneur roommate had plans for medical school but then switched out of the premedical curriculum. She was surprised when I told her I refused to perform pelvic exams. She said she never thought they would be part of medical school. I told her we had to perform them on actors (which surprised her) and then during OBGYN rotation sometimes on laboring women (which really surprised her). She actually tried to correct me: "You should ask my younger sister about that. I am sure you only observe such things as a medical student." So it seems again not everyone realizes what is expected of medical students unless it is spelled out.
One of my friends in medical school was Muslim. She told me she was okay performing these exams, but would only see female gynecologists, and only after she was married because the procedures might alter her anatomy and/or virginity.
I think cultural beliefs are just another component with how some medical students view these exams as students and as patients, in addition to personal values, sexual values, history of abuse, and much more. That is why I believe it is unprofessional for schools not to explain what will be forced on all students and under what conditions. It is surprising a higher education institution in this day and age can boast of all their anti-discrimination policies but then so obviously disrespect the students who inevitably conflict with sensitive aspects of the medical curriculum, especially when they know it has been problematic for a minority of students each year in the first place.
Even if my school is behind, I think many medical researchers and doctors do respect that cultural upbringing can render these exams unacceptable to some adults. An entire book chapter criticizes my school for failing to recognize cultural impact of how some students view pelvic exams for instance. And the developers of the CSA blood test state that alternatives to pelvic exams are needed because: "In many countries, cultural taboos prevent women from undergoing tissue sample collection."
Where I spent my childhood, many women refuse pap smears. During emergencies, women often do not meet face-to-face with the doctor. Instead, a female nurse brings them into the room, and the patient is separated via a curtain from the usually male doctor (discrimination keeps female doctors almost nonexistent). I am not saying this is a better setup but that it is an option for some women. So it seems the attitudes ("I would never accept exams except in emergencies") and procedure options ("I want to be fully curtained off") are different. Pelvic exams during birth are often saved for emergencies. And women do not submit to pelvic exams for birth control either. Women also do not receive gynecological care during general physical checkups. Overall then, I think women where I grew up are penetrated in medicine much less often than in the States, but that when they do seek exams, they face the problem of the virtual absence of female doctors.
I apologize I cannot comment more about how men from different cultures feel about prostate exams.
Maria:
You say where you live in the "developing world", there is "blackmail on both sides."
I guess this oppression in medicine (and particularly medical education) spreads.
The same seems to be true in the States. My school "blackmails" students who cry to do prostate exams because of history of sexual abuse. Also the OBGYN Dean at my school "blackmails" female patients into pelvic exams for birth control.
You say where you live, the patients most likely to be abused (via unnecessary invasive genital exams) are "extremely poor". This too is similar to what seems to happen in the States.
You can read in the article "Pelvic Exam Prerequisite to Hormonal Contraceptives: Unjustified Infringement on Constitutional Rights, Governmental Coercion, and Bad Public Policy" (Harvard Journal of Law and Gender - I attached a link in my original article) that low-income women are more likely to be forced to confront pelvic exams for birth control.
I think doctors and nurses and students exploit patients who are disadvantaged in many other ways, too, not only economically disadvantaged, but also emotionally and psychologically as well. For instance, the OBGYN Dean at my school can withhold birth control from a teenager who cannot speak English well. In this scenario, he then holds many advantages over this patient and will indeed exploit them all. First, the patient is young, and less likely to question authority because of age difference. Second, the patient cannot speak English well, and less likely to question authority because of communication difficulties. Third, the patient is not familiar with medical jargon, and less likely to question authority because of lack of medical knowledge. Fourth, the patient is desperate for birth control, and less likely to question authority out of fear she will not receive what she may need immediately. To make matters worse, the OBGYN Dean can have students shadowing him, and so now she is less likely to question authority because of overpowering numbers.
How can she tell an "older" and "knowledgable" medical "professional" doctor that he might be wrong anyway? Resisting the exam can be more uncomfortable.
Medicine seems to exploit these unfair dynamics that render the patient powerless to question the situation he is thrown into. Then because the patient feels shame and guilt and foolishness to question authority, he has little choice but to take on a passive role and allow whatever is deemed to be necessary to be done to him, and just detach himself from it all until he leaves for home, at which point he can regret what happened and possibly suffer sexual abuse and rape symptoms. And worse, he cannot report it to authority because technically he "accepted" the exam by not actively refusing it, but only due to the intimidating circumstances. In my opinion, that should never count as "full informed consent".
I am sorry you regret what happened to you with medical students disregarding your rights. Did you ever try to report the case? Or did it just seem futile?
Alan:
"Can you shed any light on why women are subjected to pelvic exams for birth control etc., not saying they are or not valid, just curious as to the possiblity that these exams are sop's from the past that no one questions anymore"
Alan, I recommend reading "Pelvic Exam Prerequisite to Hormonal Contraceptives: Unjustified Infringement on Constitutional Rights, Governmental Coercion, and Bad Public Policy" (Harvard Journal of Law and Gender - I attached a link in my original article).
1) Forcing women to choose between pelvic exams and pregnancy may have sicker motivations than mere SOPs:
a) "A strong argument can be made that the pelvic exam requirement was created with a purpose discriminatory to women. The requirement may stem from a paternal effort to make decisions for women, presuming them incapable of weighing the risks and benefits of oral contraception without an exam. Alternatively, the pelvic exam requirement may have been intended to degrade women."
b) "The pelvic exam requirement maintains gender stereotypes because it decreases the autonomy of women, derails education and career goals, and forces undesired maternal roles and responsibilities upon women."
c) "At the time the pelvic exam requirement was created, family planning program administrators knew that oral contraceptives were not causally connected with genital cancer"
d) "Equal protection doctrine mandates that a state must treat similarly situated persons alike. However, while women are subjected to invasive preventive care at family planning clinics, men are not. Men are not required to have STD screening or prostate exams (which include rectal exams) to obtain condoms or a prescription for virility drugs such as Viagra, despite the opportunity for preventative health care equivalent to that imposed on women by the pelvic exam."
e) "Requiring an embarrassing, uncomfortable exam of only one distinctly identifiable group stigmatizes that group as acceptably subject to humiliation by degrading, systematic processes. This results in a caste system in which women, particularly minority women, are denied dignity for no legitimate purpose."
2) Forcing pelvic exams for birth control is legally "invalid":
a) "International medical guidelines support the safety of providing hormonal contraception without a pelvic exam."
b) "Bodily privacy is a constitutional right that is clearly infringed upon by intrusive pelvic exams. Thus, when women decline pelvic exams they are exercising their constitutional rights."
c) "The Supreme Court has held that strict scrutiny must be met for the government to justify a law restricting access to contraceptives."
d) "The harm caused by the pelvic exam requirement—as measured by the psychological distress inflicted by a pelvic exam and the deterrent effect of the requirement—is so disproportionate to any benefit derived from it that it is clearly discordant with a cost-benefit analysis. Based on such an analysis, the Institute for Women’s Policy Research (“IWPR”) has recently taken the official position of encouraging the FDA to make oral contraceptives available over the counter, despite the acknowledged potential risks associated with foregoing gynecological exams."
Alan:
3) Forcing pelvic exams for birth control is rationally and scientifically "invalid":
a) "Requiring pelvic exams do not serve their purpose of protecting women’s health for at least three reasons: it has not been proven that oral contraceptive use is causally connected with cervical cancer, the exam is inadequate in accurately detecting the risks it is designed to identify, and the requirement actually increases risks to women’s health. The pelvic exam requirement will necessarily result in greater risks to women’s health for three reasons. First, there will be an increase in pregnancies among women denied oral contraceptives (whether due to unsuitability for the drug or refusal to submit to the pelvic exam) because all other birth control methods except abstinence are less effective. Carrying a pregnancy to term poses a greater risk to women’s health than do oral contraceptives. Having an abortion also carries much higher risks than do oral contraceptives. Therefore, women who are forced to use a less effective method of birth control face risks of pregnancy and abortion that could be avoided with hormonal contraception and that exceed the risks of oral contraceptive use, even without a pelvic exam."
b) "While HPV can be detected by a pelvic exam, of the millions of women infected with it, only a few will ever develop cervical cancer. Therefore, the exam does not accurately predict who is most likely to develop cervical cancer."
c) "Furthermore, there are less invasive alternatives to pelvic exams that can detect the increased risk of developing cervical cancer that the exam is designed to identify. An oral medical and social history is noninvasive and is sufficient to gather most of the information relevant to identifying those women for whom hormonal contraception may not be safe or for whom a pelvic exam may be warranted. In addition to an oral medical and social history, a specimen sample can be collected noninvasively to detect HPV. The vast majority of women who develop cervical cancer have HPV, which is detectable by self-collected vaginal swabs."
d) "Furthermore, the mortality rate from cervical cancer in the United States is only one per 100,000 women. Among teenagers aged fifteen to nineteen, the rate of cervical cancer is only one in 500,000, and, when limited to women in this age group who are sexually active (those most likely to be seeking oral contraceptives), one million pelvic exams must be performed to detect one case of cervical cancer."
4) Forcing pelvic exams for birth control has hurt women in large numbers:
"In a program providing low income women hormonal contraceptives, 76% of the women said it was important to be able to obtain birth control pills or injections without a pelvic exam, 86% responded favorably to the idea, 75% associated pelvic exams with embarrassment and fear, and 31% reported that these feelings had prevented them from obtaining a pelvic exam at some point."
Alan:
Alan, I can say with zero hesitation that the OBGYN Dean at my school is in no position to "care" for women. He interrupted me when I presented this topic of patients avoiding pelvic exams. I was crying at the time as well because I felt so frustrated with all these "educators" at my school trying to convince me I was the only sane adult who held such negative perspectives. Despite all this, he did not even pretend to respect this perspective held by myself, other students, and his own patients, but instead raised his voice and growled at me that he can withhold contraception from patients until they get their exams (even though I did not ask him about his own practice).
I was sent to this person by a grandmotherly physical exam instructor who assured me he was a "nice person." Indeed, he acted like a "nice person" at first but all that changed when I brought up this topic. He of course needs to emanate the air of a "nice person" in order to remain licensed for his so-called job. He can present himself as a "nice person" as much as he wants to but in the end he is hurting (and possibly sexually abusing and raping) patients due to either his inability to sympathize with and understand their health concerns and rights, or even worse, due to his underlying motives to actually take advantage of their health concerns and rights.
The article states that 75% of women associate these exams with "embarrassment and fear". I would say then physicians and nurses who force medically unnecessary exams involving penetration of sexual organs that more often than not cause "embarrassment and fear", when their motivation is to get drunk off their own power trips that make them angry enough to growl at anyone who questions their practice of skipping informed consent, are no different than sexual abusers and rapists. I know people say arguments are weakened when too much emotion is blurred into them. But I am rationalizing this as best I can, and I just do not believe doctors and nurses should get away with violating human beings in this fashion when they know their motivations are tainted, and when they know they are depriving patients of their legal rights to refuse exams.
The article, written by a lawyer, describes these exams as being "infringements" of "bodily privacy and integrity" that are "degrading" "violations" that too often cause "psychological distress" and "emotionally traumatic bodily invasion". This sounds like lawyer jargon substitutes for "rape". I wonder if it has not been done already, when the first lawyer will stop cushioning his or her arguments that male and female patients need to be heard and just take the leap to directly label this practice (lack of full informed consent for invasive genital exams) as "rape", and similar practices (lack of full informed consent for genital exams that do not involve penetration especially like forcing males to undergo hernia checks for sport physicals) as "sexual abuse".
Dr. Bernstein:
Male medical students and gynecologists confronting hostility in OBGYN wards warrants discussion. For that reason, I fully supported the article written by medical student Jacques Balayla. After all, the damage works both ways: When male providers and female patients who strongly prefer female providers are carelessly placed together, the result is obviously harmful to both parties involved.
Sadly though, instead of blaming the organization of medical schools and hospitals, he blames the patients themselves. I was hoping he would propose some clever system for medical schools and hospitals to adopt to effectively separate female patients so that only the fraction who have no preferences or who prefer male gynecologists would come in contact with male providers in the first place.
But unfortunately, he patronizingly writes an entire subsection entitled "Why Women Should Accept and Actively Seek out Male Gynecologists." I think he is dismissive to manage all female patients and determine for them what they "should accept" over who does what to their vaginas.
His proposal that "women should accept" male gynecologists is mean-spirited. He conveniently neglects many reasons outside of sexism that some women prefer same sex intimate care, such as religious and cultural upbringings, preservation of intimate and spousal relationships, sexual values and identities, and history of sexual abuse. Unless he has been in need of a pelvic exam after suffering sexual abuse, I do not think he can control female rape survivors who want female care that they "should accept" male gynecologists, as this could obviously cause much more emotional trauma to them than it could ever cause a male provider like himself to be asked to leave the room for this very understandable and sensitive circumstance, in which the patient is so obviously the one in the more vulnerable position.
He argues that "When a female patient requires gynecological tertiary care, she is more likely to be treated by a male physician and her attitudes towards this fact may impinge on the quality of care she receives." Again he is blaming the patient and "her attitudes" for the problem, rather than the system for not responding to more modern patient attitudes, and encouraging more female medical students to pursue fellowship training.
As a side note, he refers us to a study from Johns Hopkins that suggests male gynecologists express "more concern and partnership" than female gynecologists. I could not take his reference seriously though because the article I linked about anesthetized patients quoted the residency director of Johns Hopkins as saying "I don't think any of us even think about it [gang raping patients]. It's just so standard as to how you train medical students." Therefore, I do not know how these researchers at Johns Hopkins would define "express concern and partnership" with patients in the first place, when their OBGYN residency director they respect enough to grant so much power and prestige to gang rapes patients.
His blurb at the bottom of the article where he claims to be "passionate about Women's health issues as well as patient psychology" contradicts his utter lack of respect for some of the valid personal and psychological reasons behind some female patients legally seeking same sex intimate care.
I believe some men can be better gynecologists than some women for some patients. But he will not be one of them until he respects and upholds that some patients will make use of their legal rights to request same sex care.
Dr. Bernstein:
"By the way, you can describe the response you got from your school to your article."
After "Anonymous" (on Dr. Sherman's Blog) suggested that my article be presented to my school for comment, I sent the full article (and links to the Blogs) to my academic counselor on July 21, and requested that my full reason for withdrawing from the school be disclosed to the "review committee" consisting of students and faculty, which was supposed to take place on August 16.
On August 12, I received an e-mail from a student affairs staff asking for my mailing address because if the school approved of my reason for withdrawing, I would receive an official letter in the mail. I asked him to verify that my full reason had been forwarded to the committee. Somehow I doubted. And this was his verbatim response "I don't believe I have received your full explanation? I received a short (two to three sentence email from [Name of My Academic Counselor]), but there wasn't an explanation attached. Your previous request will suffice to process your withdrawal from the [School]."
I sent to him directly the full reason and asked that it be included. But I never heard back.
Last summer, I was told I could write as much as I wanted in my request for withdrawing. And at least my article stands up for future students and exposes some of the corrupt teaching and practices maintained by some instructors at my school.
Belinda
You contend that women refused male workers,whereas on a large scale that is simply
not true. It was the female dominated health
industry that shaped what we see today,
furthermore, female patients had nothing to
do with the process.
Do you really think suddenly they are going
to fix this problem of inequity? You know as well
as I do the solution must be put out in the open.
Most issues of discrimination are resolved
in this manner, they know the problem exists,yet
they lack the integrity and honesty to resolve it.
PT
SS i did not imply SOP was the only or the main reason for pelvic exams. There seem to be numerous practices in the medical community that really seem to just be carried forward, not questioned, and defended. I talked to an eye surgeon when i was considering lens implants, I had read an article and questioned the practice of having to wear nothing but a gown for the surgery even though I wasn't going under. He looked a little puzzled and said, no one every really asked, we just always do it that way. Same when i had a endoscopy to check my throat, they just always did it that way. When a friend had a vasectomy he told the doctor he didn't want the nurse, whom he knew in the room. the Dr said not really a problem, I just got used to having her there.....not saying the points you brought forward are not valid or the main cause, just curious if SOP contributes to this as well as others. By the way, did you see the article that 60% of providers carry pathneogens on their uniforms...but we can't wear underwear for eye or wrist surgery?....SOP?....alan
Alan:
I know you would never imply pelvic exams for females and hernia exams for males were merely SOPs.
Reading your comments tells me you are someone sensitive to how patients feel about these exams, and so I never disagreed with you. I was also not invalidating your statement that these procedures might continue on today out of SOP inertia.
I only stated that these procedures might have "sicker" motivations and emotional consequences for many patients than many other SOPs, and backed that up with what I thought was a very insightful article regarding your previous question about pelvic exams for contraception.
My belief is that in the case of hernia exams for males, it can be experienced as sexual abuse, and that in the case of pelvic exams for females, it can be experienced as sexual abuse and rape.
Hence even if these procedures function like other SOPs, they disproportionally abuse male and female patients, and their mental and emotional well beings, more than other SOPs.
Alan:
I want to add one specific point here: I do not believe pelvic exams for birth control are issues "that no one questions anymore".
If there is truth to the statistic that "76% of women said it was important to be able to obtain birth control pills or injections without a pelvic exam", then this practice is something that the majority of patients do in fact question.
The problem may not be then that nobody questions the practice, but that too many OBGYNS, such as the Dean at my school, become angry when people do so.
Here's my message to the male medical student/future Gyn/OB: We don't want you. You already sound insensitive and arrogant.
Male doctors have pretty much messed up big time in women's health. Many of your male colleagues, only two decades ago wanted every woman to have a hysterectomy after she finished having her family. You also still do prophylactic castrations. You used to tell women that period pain was "all in the head".
I don't want a male gyn, my friends don't want a male gyn and I certainly won't let my daughter go to a male gyn.
You've had two centuries of practice and I don't see what contribution you have made to women's health except convince them that their bodies are ticking time bombs.
Lauren
Lauren, AMEN.
And, let me add.......
you traumatized women with your insensitive pelvic exams and got away with no chaperons for a long time. Finally there was enough protestation so that women were given some protection from you although it is construed as "protection FOR the doctor." You made us give birth in the way that was most convenient for you. You did not care about the pain or comfort of laboring women and only when female physicians and nurses were able to make their voices hear (which you were too arrogant to listen to) were any positive and humane changes made to the birthing experience. And you thought YOU were the ones who should be given credit for bringing new life into the world with little disregard for the one who carried and bore the new life. You hoarded knowledge about our bodies that thankfully today is more readily available but somehow you think that YOU are the ones who should have control of reproduction and sexuality.
You talk about women's health, that's a joke, this is all about YOU and your ego. You have taken advantage of your patient population by virtue of its vulnerability and often submissive nature. To those older male doctors retiring from ob/gyn, I say "good riddance and to the ones coming in, I echo Lauren and say " We don't want you."
SS
Pelvic exams have been around now for a very long
time and without doubt have saved countless lives. It is
simply a tool in a practitioners arsenal. Note that since
your arrival on these blogs you have used the phrase
"pelvic exam" well over 400 times. Do you have some
kind of resentment with this phrase, or does it bother
you that men perform these exams.
You are aware that on obgyn forums many women
openly state that they prefer men over women and their
reasons are many. Some say women practitioners are
rude,judgmental and uncaring. Some say men practitioners
take more time and are more caring. There will always
be women who will prefer male practitioners for many
types of care,not just obgyn.
What I find concerning about your continual
discussion is this returning theme, hangup, with the
pelvic exam. It is this theme that leads me to question
your status as a previous medical student.
If you were a medical student did you ask for help
about this issue, from perhaps a therapist within the
school. Furthermore, the discussions about the facility
and the faculty are in my opinion really going down
a very slippery legal slope not only for you but for these
blogs.
Everyone these days has a choice on their provider
and certainly that has been the case for many years with
the exception of support staff. With female nursing at
94 percent, males not allowed in L&D and mammography
and the excuse that at these very same facilities men are
not accomodated.
Discrimination should be at the top of everyones list
when this type of behavior is rampant at just about every
facility.
PT
PT:
I do not understand the tone of your last post nor that of many of your others. I don't think SS or any others have constantly returned to the pelvic exam issue any more than you have constantly mentioned that there are no male mammagraphers or that the vast majority of nurses are women. It seems that you do not like women in general and do not wish to see them have their modesty concerns met just because men's may not be met as often. It is quite unfair as all the women who post here have come out to support men having the same rights to same sex providers if that is what they wish. I really thought that we had gotten past the male/female war and was hoping that we could move the blog on to finding solutions for EVERYONE. Most of the recent comments from women were just in answer to the male medical student's article and, yes, some women may prefer a male ob/gyn but NOT the majority, trust me. There has been a lot of discussion of the pelvic exam because it has been pushed on women as a yearly checkup, which has no value. Yes, it is a tool for doctors WHEN a patient is symptomatic and should be used as such. Those are the reasons that women are so angered by the practice. Men are not recommended to have yearly testicular checks, nor any other yearly checks of their genitals until they reach 50 and they start screening for prostate cancer and men are usually given the risks and benefits associated therein. Some women have just grown to resent the fact that our sexual organs have been a focus of our care from the time we are 18 or 21 years old, if not earlier. Jean
While I rarely agree with PT's agressive style I understand his point. While the comments were made by "male medical student" and may have been antagonistic and insensitive Laureen & Charlotte condemned male doctors as a whole. The issue of pelvic exams is condemned as it sounds like it should be, but it seems mainly male MD's are being blamed wholesale and it seems to be accepted. While the issue has gotten some attention and recognition it has not been adequately addressed. Compare that to the attitude toward men's concerns, tonight on the news I watched an segment on fundraisers for breast cancer...this is prostate awareness month, nothing on it, there was an segment on "the housewife" whom was removed and strip searched on an airliner, barely mentioned was the fact that two males were treated the same way. Are forced pelvic exams right and acceptable NO THEY ARE NOT, women have a right to make choices for themselves, if it is a health risk and they make the informed decision it is theirs to make not some MD who thinks they have the right to make it for them. While the practice is imposed upon women, the attitude toward such violations is not overwhelmingly stacked against women. Men's health issues including modesty is by and large ignored by the medical community and society at large with much more ease. I believe that is at least in part PT's point, and to that end I have to agree. I recently related a free advice line for women at a major hospital in Indy who had a free advice line for women, and one for children, but none for men. The proliferation of women's clinics and rarely one for men are all symptoms of a problem men face. You can drill down to one subject, pelvic exams, and draw conclusions, but if you look at the larger picture...men are definately not at an advantage...alan
Jean
You are correct in that I don't want to see women have their
modesty issues met. In fact, that
is how I see the solution for men
which would force uniformity for
all.
I have tested nurses on
various nursing sites and gauged
their responses. Its so obvious
they couldn't care less. The solution
simply is a higher infux of males
into nursing and other programs,
resulting in equilibrium.
I never said I do not like
women in general, I just hate the ones
in healthcare. To the extent that you
and others on this blog can never
comprehend.
PT
Alan:
My impression is that both Lauren and Charlotte have most likely had negative experiences with male doctors, which has thus caused them to have their opinions. And also PT, who most likely has had negative experience with female health care providers, especially nurses. Negative experiences always taint our perceptions and cause us to avoid similar situations in the future. I am in that same boat as I feel you are, too. At least now, at the very least, we have learned that we can speak up, complain and perhaps shape our medical experience to better suit our needs/concerns.
The hospital that advertised the help line for women and children but not men is insensitive and discriminatory. If enough men called in and complained, perhaps they would get the message. I think that just not enough men complain. Women should also call the hospital and point this out. If any women and men you know would be willing to do this perhaps it would be a starting point. Jean
Alan, I apologize if it sounds like I condemn all male doctors, I don't and actually I am married to one. Lauren's post brought out a strong agreement from me which was somewhat emotional and hard line because of my own personal experiences. I guess we are all products of our own experiences and I know that, at age 60, my experiences with, for example, childbirth, are different than women are experiencing today. For example, today there ARE many available women obstetricians AND there have been many changes made in the way women are treated. This blog provides a nice opportunity to vent. I think that those of us who have found this blog and choose to post are doing so because of traumatizing experiences so we have a hard time being neutral or perhaps even being fair some of the time.
Concerning male modesty, I am sympathetic and fully supportive of men getting all male teams and having male nurses. Here is the problem though; I suffered some modesty/dignity violations during treatment for cancer. In discussions with my husband and other male colleagues of his, they see modesty as less important than good health care. I have said; "you would not have liked to have been treated like I was." The response is always that they would not care what gender their health providers were as long as they got THE BEST MEDICAL CARE. Also, the insensitive treatment that I endured during radiation had been experienced over and over and IS experienced over and over by male patients daily but THEY DON'T SAY ANYTHING ABOUT IT. On the other hand, I wrote a very, very lengthy letter to many folks including the CEO at our hospital and met with the director of the Radiation Oncology Center and others. This was very difficult and distressing for me but at least I did something. I wish someone had done this before I had to go through this but the men just grit their teeth and say nothing. But, here is a big point and the reason why I come down so hard on male ob/gyns and like Lauren would not go to one or want my daughter to go to one. Although more women are becoming physicians, medicine has been dominated by white males. This is slowly changing but they have had control. Often these male doctors did not respect the opinions of their nurses or anyone else. So, if you have those who have had the control and power taking the stance that good health care trumps modesty, you not only have insensitive treatment of women but also of men. So, if women have gone to bat for women against prevailing insensitivity, don't be angry, they have gone up "against the machine." Does this make sense?
"The response is always that they would not care what gender their health providers were as long as they got THE BEST MEDICAL CARE."
Such a simplistic answer from, supposedly, such intelligent medical professionals. Here are some of the nuances to that answer:
-- We all want the best medical care. They're creating a line with the best medical care on one end and gender choices on the other -- as if the two can't at least meet in the middle. False dichotomy. A dichotomy is a set of two mutually exclusive, jointly exhaustive alternatives. Best medical care and gender choice are not necessarily mutually exclusive. Doctors who use argument need a 3-credit basic course in logic.
-- Many young doctors have not had serious health care problems, esp. those related to intimate personal procedures. So...they don't really know how they would feel. They're telling us how they think they should feel.
-- To a significant number of doctors, "best medical care" translates into a physical formula, i.e. curing the body or a body part. It separates the person from the body, the soul from the body, the mind from the body. Cure the body at all cost, is the philosophy, the rest will take care of itself. Well, maybe, maybe not.
I present these counter arguments for those to use when they hear this argument used.
I am impressed about how the discussions on this Patient Modesty thread has changed over the number of volumes from detailing the individual abhorrent experiences, to instead now one of trying to explain the mechanisms which has led to those experiences. Trying to understand the pathologic mechanisms of a disease is the pathway for devising a cure and so trying to understand the reasons leading to the origin of the experiences revealed here is the way to begin to find ways to change the system.
Obviously there is misunderstanding on both sides, patients and the medical system. And this misunderstanding may lead to a status quo situation with no improvement in relationships and understandings that must be improved. But what is leading to this barrier of misunderstanding? Can we overcome this barrier by writing and reading blogs? Is something more necessary? ... Is something more necessary? Any suggestions? ..Maurice.
Dr. Bernstein,
I think the biggest problem between the two sides is a lack of real, effective communication. To quote from The Tao of Pooh:
"Lots of people talk to animals," said Pooh.
"Not that many listen though."
"That's the problem."
I agree that if things are ever going to effectively change, something needs to be done to break down the barrier of misunderstanding, as you refer to it. Since I seem to be in philosophical mood tonight, in the words of the ancient Chinese philosopher Lao Tzu, "A journey of a thousand miles begins with one step."
Is writing and reading blogs enough to effect change? I don't think so, but it is a good first step in understanding the issues and learning how to address them, and also a good way to exchange information and resources. I believe that the second step is to take what we have learned, and apply it in our own situations, as several who contribute here have already done. Talk to your provider(s), let them know your preferences and don't let them blow you off. Make them respond to your concerns.
Of course there's a right way and a wrong way to do this. Being aggressively confrontational is something that is best reserved for when it's really needed. I believe a better approach is to be polite, but firm, but keep asking your question(s) until they are answered to your satisfaction.
What troubles me on the one on one approach of trying to make change is that the problem, even though of the greatest importance or significance to the small proportion of the patient population, will not be systemically resolved by this approach. Yes, perhaps individual patients who "speak up" to their healthcare providers might find their personal benefit to that action but I am sure that many more who are afraid to and will never do so will continue to be frustrated and fail to have their modesty issues met.
That is why, as I have been calling for in previous Volumes, a more general activistic approach to "spread the word" and have a discussion on a system-level (not just some one on one) to change the misunderstanding of the medical system that modesty is an irrelevant issue to the entire patient population. To me,as I have said previously, the right approach is to ORGANIZE. ..Maurice.
I agree with both of you, Hexanchus and Maurice. Yes, getting the word out and organizing on a larger scale is important, even necessary. On the other hand, you can't underestimate the power of only a few individuals who make their case known assertively on a one--on-one basis. It's amazing how much only a few incidents affect us as human beings. A doctor or nurse who faces only one or two patients who make their needs known and won't be diverted from their request -- that experience will come back to them almost every time they meet patients they sense to be uncomfortable about modesty, and they are more likely to ask preferences rather than being confronted again by a patient who is assertive.
To Doug,
There is a huge problem here, it seems that some people's idea o "the best medical care" is sometimes radically different from what Doctors usually recommend. For starters, some patient's idea of preserving their personal dignity might include:
a) absolutely no intimate procedures, ever,
b)no sexual history taking, and no blood samples which sole purpose is to test for STDS, especially with EMRs, once the genie gets out of the bottle you won't succeed in putting it back in;
c)needless to say, no cross gender caregivers. Or at least, absolute right to choose caregivers, and veto them, especially if a request was made and the patient was not only rebuffed but disrespected.
Whether or not someone chooses to become part of an organized advocacy movement would depend on their goals within advocacy.
If their perceived outcome is to support their individual rights to their body,(and accessibility of anyone therein) thereby becoming a stronger and more vocal personal force: then one would be satisfied with a sort of “one-on-one” advocacy. I’m aware of many people who have gained that sort of strength on this and other blogs.
If their goal is to change a system, thereby benefiting as many people as possible in perpetuity, then mass outreach and education is the only solution.
My concern as to the ongoing “one-on-one” approach is that most people in their lifetime rarely ever have just one or two medical scenarios. This means that unless the system changes, one would have to (perhaps exhaustively) advocate for themselves every single time an intimate medical situation arises. We may make our point with our doctor, but what about each facility we may have to deal with on a continual care basis? The places we may be referred to after that?
So, would it not be better to make as much impact as possible, for as many people as possible, within an attempted advocacy stance?
Suzy/swf
I went back and read some of our founding thoughts regarding such an organized movement, and this was the Mission Statement and Goals written at the time….
“MISSION STATEMENT:
We believe that each patient is an individual and as such has specific preferences and needs including what accommodations they require to maximize comfort when their modesty must be compromised in the medical experience. Our mission it to act as a liaison between patients and providers in establishing, understanding, and executing the policies and procedures essential to that end. When appropriate we will act as advocates for patients to achieve that goal through interaction, education, and referrals to both patients and providers.
GOALS:
Our goal is to help patients achieve dignified and respectful healthcare through education and information. Everyone has different needs and expectations of their healthcare providers, and we provide choices and options in obtaining those needs. We understand that modesty, privacy, and respect are primary needs when facing procedures and we promote educating providers in the sensitivity of those needs.”
These were goals that did not promote gender wars. These were goals that saw all patients as people, with no regard toward gender, and the real possibility of working together toward that goal. When all here is said and done, is it still possible to expect that level of co-operation from each other?
Suzy/swf
Jean, I agree most of us are molded by our experiences and react accordingly. I would also agree that most of the people who continue to post here do so because they have had some type of experience that was traumatic for them. This is theraputic in more than one way, it's venting as Charlotte indicated, it also helps as for a long time I felt I was the odd ball, knowing others felt the same way was impowering. What I read on this and Dr Sherman's site emboldened me to start speaking up for myself and addressing those whom I felt not respecting my or others modesty. Charlotte it does make sense, we all see things from our experience. From a males perspective while in the past white males controlled medicine today the vast majority of health care providers are female. While over 50% of med students are female over 90% of nurses are female. The proliferation of NP's is changing how care is delivered, the majority are female. The vast majority of proceedures are either conducted by nurses or assisted by nurses. And attitude toward men's modesty and women's are still viewed differently which contributes to men not speaking up. At the very time we brought females into being MD's we eliminated male orderlies. I would challenge providers contentions they don't care about gender. If you read blogs like allnurses many ask for accomodation and do have preferences when they are the patient. But more to the point as was addressed, why do the have to be exclusive. Gender nuetral benefits provider scheduling and economics not patients...Charlotte I do understand your frustration,,,thanks...alan
Alan:
I agree wholeheartedly with you. I also used to think I was the oddball for feeling they way I do about medical modesty issues and I totally understand how men (or those who are modest) feel about going into a health care system that is so heavily populated with women, especially in the nursing and tech fields. I also feel better about "venting" on this blog and I think that if I am ever in the position of needing care in an intimate area I will definitely be able to speak up and make my preference known if need be.
I think it would be wonderful if there was a larger advocacy group/movement for promoting the idea of patient modesty and the importance of same gender care when it is requested but I do think it would be a vast undertaking. I think it would be better to address the issue on a large scale because I agree that a lot of people are bothered by this but just "suck it up" and do not feel they can complain or say anything and also have not found these blogs to make their feelings known. Many of them may avoid doctors altogether because of this very thing. That is why I have said before that maybe the posters here need to talk with family and friends to see if there are others out there to join the cause (and also about ideas such as complaining to the hospital that advertises a health care hotline for women and children but not men). Just small stuff like that may get the ball rolling a little but in the meantime, unfortunately, I feel like it is something we will have to address as individuals when the occasion arises. Jean
Jean, if you could set up prgram to get the ball rolling, what you you see as the steps. I have given this a little thought. My thoughts include:
1. co-ordinate a small group who are interested in the issue
2. define the goals and approach
3. identify the barriers and challenges to getting it to a larger group
4. identify funding requirements
5. create a website to:
a. provide information
b. work as sometype of advocate or liason for specific issues
6. identify how to drive larger numbers to the website
I think if you could create at a min. the illusion that the website represents a more significant number and the potential for a larger number to view a facilities short comings, it could be the start to a bigger benefit but would definately benefit the user, the question is how do you get it out to a larger audience and one would have to be very careful that whoever was responding did not open up slander issues.
If anyone is interested in rekindling the webite idea, I did keep all of the information and constructing ideas from a small group of advocates a few years ago. I don't believe any of them would mind sharing the work we were establishing, although they could email me if they did.
boshemian2@aol.com
Some of it is contained in a construction blog, which has a fairly good foundation of mission statements, goals, and letters to medical facilities.
It doen't cost a lot to build a website these days, and you will find that information sort of blossoms from there.
The old construction site still gets hundreds of hits per year, so you will find interest is still out there.
swf
Re: ANON Sept 19 8:47
"4. identify funding requirements
5. create a website"
Designing your own webpage will be fairly easy, but consider that you will probably need help securing and linking to the incredible amount of space the venture takes. Especially if you choose to be inter-active by some nature. So, when obtaining your bid make sure they are including the weeks of testing “interactive accessibility “.
Consider in your fundraising that the site must also be funded on a monthly or yearly basis. Funding is not easy, so make sure you secure it ahead of time.
Use (and copy write!) a logo. ( I have three) It gives the impression of a well founded, professional advocacy movement that would garner accountability. There are currently (that I know of) three other groups attempting a like site. Make sure to protect whatever you want to remain your group’s own property.
Best of luck! The bonds you create from around the world will be very rewarding. If you manage a reasonable amount of funding, the time from your design to going live should really just be a matter of months.
swf
I agree, I agree! My caution: this advocacy should be much more than another blog like mine or Joel's. It should not be a place for, even therapeutically valuable, "moaning and groaning". (We have that here!) It should be a place for coordination of the advocacy group. It should be a place for stimulating and enhancing approaches for advocacy. Good luck. ..Maurice.
Yes Dr. Bernstein....after speaking to a web designer awhile back, it was suggested that an "off property cache" that amounted to a shared email for the web moderators could be attatched to share that sort of information: but not for public posting as in a blog. The website ( as we saw it) would be for information about facilities who practice respectful options in healthcare, perhaps articles, and links to sites such as yours and Dr. Sherman's. The idea as we saw it was for the distribution of information, availability of services, and accountability when this is neglected or denied.
I still have faith in the website, but my talents obviously do not ly in fundraising. Perhaps someone here has this talent, and the wealth of work that the advocates did could be passed along to them and not go to waste............
swf
A website may be a good idea. The main problem I still see is that there is no way to know how large of an audience it would have. It seems to me that when it comes to this issue you can view people as being on a bell curve. At one end would be individuals who have no modesty concerns at all. At the other end would be those of us who have a great concern and are willing to either complain to get what we want or are avoiding medical care altogether. That leaves the middle: those who probably have some degree of modesty but just accept the care they get, view it as just another embarrassing moment and then move on. But there may be quite a few in that group who would appreciate more attention given to this issue. The question is how to "capture" them. I think if a website was developed it may be best to title it in the vein of "getting dignified, respectful medical care on your terms" and perhaps not specifically mention the modesty word until the person actually logs on to the site. Does anyone understand where I'm coming from?
Personally, I have no experience in creating websites nor fundraising. Most of my thinking up to this point has been how I will approach the situation if and when I ever need medical attention.
I was thinking, however, that another possiblity would be to write op-ed pieces to major newspapers. (I am showing my age when I talk about newspapers!) But I know in the Sunday edition of my city's paper there are opinion pieces on various subjects. To have any credence, however, and chance of getting published, it would probably be better to be an "insider" in the industry, although I have seen pieces from common folks, too. A few months ago there was quite a few posts from Compliance PHD; someone like that would be an excellent persome to write such a piece. He seemed to understand and be sympathetic to the issue. I thought the best chance of getting something like this published would be to go at it from the male patient's viewpoint. Perhaps title it something like "Choice, dignity and advocacy lacking in male health care". A lot of issues we have discussed here could be highlighted, such as a shortage of males in nursing and tech jobs, lack of male centered clinics, shortage of advocacy for male specific diseases, etc. The piece could also use these issues to explain some men's reluctance to seek medical care. I think it would make a great opinion piece if someone of some credibility would be willing to write and submit it. Just and idea. I think the more the subject is thrown out there in whatever form, the greater the chances that it will be taken seriously by the very people we want to see it:the medical community. Jean
All this discussion sounds fine, but if it goes this way there's one element I believe must be present. Note that Dr. Bernstein's blog, and Dr. Sherman's and my blog -- have one important element it common. They are not anonymous blogs. You know who we are.
The medical community will never take seriously anonymous anecdotes about anonymous providers working at anonymous hospitals and clinics. Those who really want this issue to fly must come out out the closet and use real names. Provide real experiences at real hospitals and clinics. Not just the bad -- but the outstanding experiences, too.
44 volumes of anonymous experiences is enough. We need to start documenting real experiences at real places involving real people.
My opinion.
No Penis,No problem
This is the pre-req for working
in the various womens-only health-care services. Additionally,your
horizons are much expanded as you
can work in all the services for men as well.
No one will question your motives as they never have in the past, even military and mens prisons. Have a taste for some
BDSM=bondage&discipline,submission
&dominance,no problem as many female nurses have this covered.
Striking the erect penis of their male patients with a spoon has this category covered. How about some CFNM=clothed female naked male action,look no
further than our military induction physicals or strip searches in mens prison,plenty of
jobs for women there.
Careful though as there are many imposters pretending to be a
female nurse as this seems to be a
popular pasttime and a big problem with state nursing boards.
Seems some female clerks at the meps military induction station in Jacksonville florida ,1974 had the idea to don a white jacket so that
their presence would seem more professional among the many nude men recieving physicals.
If a little voyeurism is what
you desire then fret no more,plenty
of opportunity for that at hospitals,surgery centers and intensive care units.
The point is you are going to have some tough competition out their with all those fake nurses,let alone those cns's and
medical assistants at physican offices calling themselves nurses.
They just want in on some of the action too. If its young boys
you are after you might consider a
job as a school nurse. Lots of
hernia exams so forth and etc,but
lately schools are replacing nurses
with medical assistants to save money. Besides,with all the female
teachers lately being arrested for
having sex with their male students
pickins might be slim.
You might consider pediatrics as
there are virtually no male nurses
in hospital pediatric icu's.
PT
swf I am going to contact you in the next couple days to discuss how we might move some of this forward. One has to remember the fear of being, for lack of a better term "exposed" or portrayed as uncaring or abusive can create as much benefit as doing so. If a facility is confronted with the possiblity of being placed on a web site as violating patient modesty it does have more effect than if a individual contacts them. The legitimacy of the website if done properly can have more impact than the actual number of people involved. Example. John Doe from XYZ patient advocacy group contacts Hospital A on behalf of patient B, requesting information as to what option the patient has for same gender care. I think it goes to a different level than John Doe calling, same post event. john doe contacts Hospital A on behalf of patient B regarding a possible violation, giving the option to post their reply on a website puts the spector of mass exposure of the violation. They have no way of knowing if the site has 100 or 100,000 viewers. While the issue of figuring out how to go viral may take time, it could have individual benefit which has the potential to start word of mouth....
Interesting thread on allnurses, 9 things nurses ...a little disturbing. Of course item 1 is WE LOOK, and the example of course is a male with a large penis. And this ladies and gentlemen is a perfect example of why we as patients do not feel the context of the exposure makes all the difference. Providers have declared themselves as professionals, yet this clearly unprofessional post of this attitude is supported not condemned by her fellow nurses. She says they look, they talk, but fear not HIPPA keeps it among nurses...well I feel better now, clearly I must have been wrong when I didn't feel comfortable exposing myself to these professionals....alan
After reading this blog for several years,I'm finally hearing something constructive coming togather.The male,female fight was getting alittle stale.Both sides want the same thing,so fighting among the sexes will solve nothing.I think anything that can be done to move the modesty issue foward is a good thing.We have a long uphill fight ,because they are not going to give up control to you very easily.I think some are right to zero in on one or two of the worst offenders.Word would spread and no one wants negative publicity.Ask for assistance and see were it goes.Good luck. AL
Alan, you're 100% on target. The realization by the medical community that a group whose strength of numbers has the potential to be enormous has organized to stand up and make a public issue of the injustice of modesty violations will have a great impact. When they know that their actions will result in a negative reaction be it monetary, public scorn, or both, things will begin to change. Brilliant thinking. Thank you.
Warmouth
I liken it to security camera's. We install them at our business outlets and let them know we monitor them through an internet connection. Every once in awhile we will turn them on, say hey I saw this or that happen, good job. It puts that spector they MAY be being watched that has as much benefit as us actually doing so. We can't spend all day watching screens, but it is effective in keeping them honest for fear of negative ramifications....alan
The comment on allnurses regarding
the thread 9 things nurses don't
want you to know under nursing
articles.
Interesting that the author of the article is in nursing education. Even more interesting
regarding the first comment
incorrectly states that it is not
really a hipaa violation to make
the comments mentioned.
According to every state nursing
board it is considered sexual
misconduct to leer at a patients
genitals as well as making sexual
comments regarding a patient or
pertaining to their genitals.
The comments did not really surprise me as much as the ignorance of the author regarding
hipaa and what constitutes sexual
misconduct.
PT
PT, it's OK with me, as moderator, for you to provide this thread with a link to the allnurses page to which you are referring. Thanks. ..Maurice.
the post PT referenced is really disturbing. The vast majority of nurses felt it was funny and many justified talking about a patients penis for amusement. I do believe this contributes to patients modesty issues in the medical setting. When nurses claim professional privledge and then say things like these nurses, why would we trust them
Dr B
Alan first referenced the thread and brought my attention to it. Here is the link.
http://allnurses.com/nursing-blogs/nine-things-nurses-618771.htn
PT
-alan: Looking forward to your communication.
-I have decided not to comment (yet)at the allnurses site. Too many times a thread is closed due to comments from 'outsiders". I would rather wait and learn from their comments, because quite frankly..knowledge is power.
Am I surprised at what they have to say? No. I believe it's great that they posted the truth. It sort of proves what we have been saying here all along doesn't it? If ever it were proven that people need some sort of affirmative action that speaks to the dignity of their bodies, it would be on that thread.
Suzy/swf
I am having a problem finding the article after pasting the thread. Please advise. Thanks
Well...I'm a big enough woman to admit when I'm wrong. It seems that I'm not capable after all of allowing them to post this kind of smut and not say something about it. I said earlier that knowledge was power, but perhaps we have all of the knowledge that we need.
swf
Link should be:
http://allnurses.com/nursing-blogs/nine-things-nurses-618771.html
--amr
What would be the
"9 Things Patients WOULD Tell You"?
If we had the chance (and they posted it)...what would we say?
Suzy/swf
The thread regarding nine-things
nurses and the author raises some questons. Many on allnurses assume complete anonymity,not so. The author
works for a retirement home and as
such does not care for patients in
general.
Her clients are 62 and older,not
middle aged women with nausea/vomiting/abdominal pain,as one
of her 9 "pet pieves". She states her
occupation as nursing education,I think not.
Nurse educators are most often teaching at community colleges with
as little as an associate degree or
employed at hospitals managing each
rotation of student nurses.
From what I have gathered about
the author,she hands out meds in a group home with an emphasis on alzheimers.
PT
Suzy swf has a good idea. Several months back, I posted an article on our blog (Dr. Sherman and myself). The article is called DEAR DOCTOR AND NURSE:
15 SECRETS YOUR PATIENTS WON’T TELL YOU. I would ask that, if interested, you read that article and then add anything I've left out or that needs elaboration. You can find the article at: http://patientprivacyreview.blogspot.com/2010/08/dear-doctor-and-nurse-15-secrets-your.html
I'll add your suggestions to the article.
Swf
I see you too are in nursing education,referring
to the author of nine-things-nurses. Certainly,posting
derogatory and cynical humor by medical personnel
are forms of verbal abuse,disrespect and the dehumanization of their patients.
This kind of humor is indefensible and cannot
be tolerated even in events of stress or exhaustion.One
could only imagine the implication if I as an example were
an elementary grade teacher and on a teacher's website
suggested that it's ok to attempt to have sex with my young
female students.
Just how long would I stay employed in that capacity
is the question. Would it be appropriate to make a
comment on any professional blog contrary to what
constitutes professional behavior.
PT
PT:
? I agree with you. I am not sure what you mean. Letting nurses know how we feel is not "nursing education". I am not understanding your point.....
Suzy/swf
I would like to know what you all think about what kind of message, if any, this statue at a University of Kentucky hospital sends to patients, especially male patients.
http://www.lex18.com/news/new-statue-in-front-of-uk-hospital-causing-controversy/
Apparently, it is a statue of a nude male in front of a children's hospital. I am not sure if it was an appropriate location for this statue, though I don't find it tells a significant message about patient modesty any more than perhaps the photo I took for this Volume. Probably, a worse statue to place in front of a children's hospital would be the Berne Switzerland "Kinderfresser" (child eater) statue which you can see in it's full glory by clicking on this link. ..Maurice.
swf
My point was regarding nine-thing-nurses and the author who by the way is in nursing education. Is this
the standard that nurse educators have stooped to.
Are there standards within the American nursing
association or state nursing boards, regarding submitting
derogatory, abusive comments regarding patients on
nursing sites.
PT
Interesting statue. Without making too much of this, I do think it indicates certain cultural attitudes:
1. Historically in Western culture, naked male statues indicated a pride of maleness, it's strength, vigor, creativity, power. It's interesting how many famous males wanted nude statues depicting them. That's with statues, probably because of their more public display.
2. In Western painting, you get the above, but you also get the male nude as wild, threatening, frightening, untamed, dangerous. Perhaps because of the often less public display of that art form.
3. In modern art, esp. post-modern art, anything goes. You'll find detailed, more graphic nudity of both males and females.
4. With statues, because of their public nature -- in our politically correct culture, it's much safer to go with a graphic male nude than a graphic female nude. Note that, historically, many female nudes are draped and/or don't show genitals. Male nudes are rarely draped and often do show genitals.
5. Medical art, historically, is full of both male and female nudes, but mostly male nudes. Note the recent traveling display of graphic real nude bodies showing muscle structure, were mostly male. It's may be hard for non scientists and patients to understand, but among doctors and scientists, there seems to be an aesthetic associated with the naked body having to do with the beauty of the science, the beauty of the mechanistic aspects of how the body works. That may be part of the aesthetic behind this statue being placed in front of a hospital.
6. Does this statue indicate anything about current cultural attitudes toward male modesty? I believe so. Male modesty is not nearly as much a consideration as female modesty. That will carry over into how men are often treated in medical situations.
7. But I think the statue more likely represents that older ethic of the male body as symbolic of strength, power, exuberance, creativity - plus that scientific aesthetic connected to the beauty of the body's mechanical aspects.
Just some thoughts. Personally, I'm not at all offended by it. I think it's a fine work of art.
An other point about the statue: Since it is by a children's hospital, it would have been more appropriate to create a statue that children could relate to better, rather than an adult, nude male. But this just may show how those selecting the statue were not outward oriented, but inward oriented -- not patient oriented but medical professional oriented. To whom does the hospital belong? Who "owns" it? The medical profession? Or is it owned by both the medical profession and the people they treat.
Note that the verbs "to doctor" and "to nurse" are transitive verbs. They must take objects. Doctors and nurse must have an object to act upon. Without that object, they have to meaning. The irony is that, although in grammar the verbs act upon what we call an "object," in real life medical professionals are not acting on objects merely. But human beings.
But, back to the statue. The fact that it is in front of a children's hospital and is not designed to relate to children may have more to say about attitudes and the culture of medicine today than anything else.
Yes,Doug, we teach our medical students that they are not treating the liver of the patient with alcoholic cirrhosis but are treating the patient.
With regard to the decision establishing the location of the male nude statue in front of a children's hospital, I would challenge Doug and suggest that the facts of the action is at this point unknown and therefore cannot be used to generalize and explain the attitudes and culture of medicine today. ..Maurice.
Maurice:
Statues and memorials are interesting. They often tell us less about the facts behind what they memorize and more about the attitude and culture during the time the memorials were installed and of those who installed it. I suggested both positive and negative interpretations.
Whatever the intention or meaning of the statue, the fact that it is front of a hospital does say something about the medical culture, good, or bad or both -- whether the medical culture likes it or not. Would you say a statue in front of a school says nothing about the educational culture and attitudes of those who installed it? Or a statue in front of a zoo or aquarium?
The statue's meaning, whatever it is, is somehow related to the values associated with that hospital. Now, who was on the committee that selected it? Administrators, artists, doctors, nurses, patients? And why did they select it?
But you're right, Maurice. We don't know the story behind why that particular statue was selected for that spot. It would be interesting to find out.
What is identical to what we are discussing on this thread was written in the news report of the response of the public relations department of the University of Kentucky:
"The statue is turning a few heads, but UK's public relations office says it is art and has not received any complaints."
See.. no complaints equals no problem. Doesn't that sound familiar? ..Maurice.
On a topic that has been discussed here, I just happened to run across a copy o the current sports pre-participation physical form that is used here (all students grades 7-12 are required to have this form filled out by a physician every two years).
It's interesting to note that there is no longer any reference to genital/hernia exams for male athletes on the form - it was apparently removed when the form was last modified in 2010.
It looks to be a lot simpler than the old form. There are only two sections with 6 or 8 items each: medical (mostly cardiovascular, plus vision & hearing) and musculoskeletal.
OOPS!
My post from yesterday should have read:
(all students grades 7-12 who participate in extracurricular sports activities offered through the school are required to have this form filled out by a physician every two years)
My bad.......
Dr. Sherman and I have posted a new article on our blog -- written by Steven Z. Kussin, M.D., author of the new book "Doctor, Your Patient Will See You Know: Getting the Upper Hand in Your Medical Care."
I think you'll find it interesting and empowering.
You'll find it here: http://patientprivacyreview.blogspot.com/
Great article! I am glad to see that there are other physicians (besides the ones moderating these blogs) that "get it". It is unfortunate that the author had to be a patient to totally experience what other here have been complaining about. I fear that what he says may be true, though, and that is the nature of the health care industry today may not encourage the practice of these considerations. As the title of his book seems to indicate: we all will have to empower ourselves to get the kind of care we want, not only in the privacy/modesty context, but in all areas of medical care. I am making a concerted effort to educate myself on these points so that if and when the time comes I will be prepared to speak up for myself and have some "ammunition" to back myself up. Jean
Before the U.S. Supreme Court today, the issue of strip-searching anyone (or only males??) admitted to jail even for a minor offense. From USA TODAY:
"The dispute began in March 2005 when Albert Florence was picked up on a warrant for an outstanding fine and brought to New Jersey county jails where he was strip-searched as part of routine processing. Florence had paid off the fine, but the warrant had not been removed from a state computer.
At the first jail in Burlington County, N.J., Florence was ordered to open his mouth, lift his tongue, hold out his arms, turn around and lift his genitals. At the second jail, in Essex County, he was also ordered to squat and cough as authorities looked for contraband.
After the warrant mistake was discovered and he was freed.."
Any comments? ..Maurice.
This is very interesting that your comments were posted. I received an e mail today from a political icon who wanted to know what was important to do over the next ten years.
I talked about the right to dignity, our medical system, prison system and the airlines. It will be interesting if I get a reply. I will keep you posted.
The individual listed above who was stripped due to their mistake should sue the system for damages at the maximum that can be given and should be on every talk show in the country.
If the people who did the stripping had knowledge that this issue was already cleared, they should be criminally prosecuted.
belinda
"The individual listed above who was stripped due to their mistake should sue the system for damages..."
belinda -- This issue goes beyond whether it was a mistake or not. In this case it was a mistake. But the big issues is whether anyone can be picked up, for let's say, parking violations, or any other nonviolent crime, and then be strip searched -- and whether the police have to have any reason to think the individual is hiding anything. Police claim that anyone who will be put into the general prison population, even for a short time, should be strip searched for the protection of the prison population. That's the issue.
So -- anyone, for any reason, let's say you haven't paid your parking tickets, could be picked up and stripped searched. And, if you follow the cases out there, you'll see this involves women as much as men. This case just happens to be a man.
My opinion -- we're turning more and more, slowly, gradually, into a police state. In cases like this, human dignity looses because it's just more efficient to strip everybody. And stripping "prisoners" or anyone detained, has become more and more a strategy, a method to intimidate and get someone to talk.
This issue while not medical has commonality. Two sides of the same issue. I am a modest person, however, given the world we live in I am a little less disturbed by the strip search than perhaps how it was conducted. Unfortunately the world we live in today puts law enforcement in harms way to often and from a variety of people. I live in a small town, it has been years ago, but our sheriff was shot and killed by a prisoner after his girlfriend smuggled in a gun. She came for a visit, no female officer was present to do a pat down so they let her in without a good screening and he paid the price. So, from the law enforcement side of this, quite honestly I understand. How many officers are killed in routine stops, the quiet friendly neighbor in CA just walked into a hair salon and killed 8 people. HOWEVER, the need to do this requires those doing it to go the extra mile to make it as tolerable as possible. They need to be trained, they have to have private facilities, they have to have gender options THAT THE PERSON BEING SEARCHED IS COMFORTABLE WITH. They should have a screen where while two people are present, only one is observing the actual sensitive areas. This is the facet that violates most peoples feelings. TSA had the choice of using the stick outlines for scanning but chose the most graphic solutions (I understand some conflict of interest with the company producing them influenced that), giving female reporters equal access is not the problem, how it is done is. The problem comes when those intruding on a persons modesty feel they not only have the RIGHT to determine the need, but the person being subjected to it needs to accept HOW it is delivered and the person needs to not only submit, but accept. Often the how reflects the need and convience of the person doing the invasion vs the person being subjected to it. I would be interested in knowing the manner in which this search occured as much as why...alan
I agree with you, alan. But the HOW is more often influenced by efficiency than it is by the dignity of the person. And this is where there's the medical connection -- it's more influenced by an institutional focus than it is by a person/patient focus. I do agree that the safety of the police is important -- but, as you say, that can be accomplished and dignity can be preserved. But, FOLLOW THE MONEY. Protecting individual dignity may cost more for many reasons, including staffing. It may not have to -- if we use creative thinking -- but the assumption is most often that it will cost more.
Mr Florence will get a nice chunk of cash,false arrest
assures that and most certainly their procedures will
be looked at. I knew of an exact case like this that
occurred about 22 years ago. A woman arrested for
an outstanding traffic violation that she had in fact paid.
She was given an apology and $10,000, although I
doubt she was strip searched and probably because she
was white and female. I'm certain Mr Florence will get
more than that.
PT
Doug, could not agree more. I think the desire by the administration to drive profits has changed the way the issue is addressed and that has driven the way it is viewed. The most obvious example is the elimination of male orderlies. I do think while the administration drives it, providers buy into it either by agreement, the need to comply, or simply becasue their work load requires they do it so they justify. While I understand that part, I still can not bring myself to hold them harmless when they deny, ignore, use the path set by the administration as an excuse for taking the easy way out when there are alternatives. I also hold providers accountable for being less then honest about issues such as the difference when they are the patient. I do believe driven by the administration modesty is compromised for profit, but I also believe providers use it as an excuse as well.
What administration? These practices have been main stream since the Civil Rights Movement when Title VII was introduced and the medical community decided to ignore the privacy content.
belinda
So today I saw a new ambulance chasing ad on TV. Apparently there is a problem with a new mesh product used to repair vaginal prolapse. The ad suggests that if the viewer has had this operation, they might be eligible for compensation. They give you a number to call and specifically state that "female" lawyer will answer the phone and help you.
Do I need to connect the dots, or is it obvious.
--amr
SWF, I tried to contact you a couple times with no success. Do you have a forum or some way to contact reguarding possible efforts to move this forward. Is there a safe way to contact email, blog, ? alan
alan:
I am sorry..my email is spamming everyone. Please send it again and I will check closer. Sorry to have missed your contact!
swf
On Monday I had Prostate Brachytherapy performed in the UK by the NHS. I told my surgeon when my cancer was diagnosed and Brachytherapy suggested, that I would not have the treatment with any females present. Non negotiable, absolutely firm decision on my part.
The operation was performed as requested and I am now recovering quite well post operatively, although I appreciate it is still very early doors at present.
My worries pre operatively were more about having a GA for the first time, knowing I had an all male team helped me otherwise much more relaxed.
If it matters enough to you to want same gender care, make it clear, make it clear you will not budge, and be absolutely steadfast, they WILL find a way to accommodate you.
My doctor wants me to have an open chest lung biopsy. Due to other medical complications I am hesitant. The icing on the cake is that I have these modesty issues and due to complications and seriousness of the procedure, together with other health risks I have said NO
My advice, already written to this thread many times in the past, is that you should be making your personal medical decision especially for potentially serious and life-threatening medical conditions based only with regard to the medical/surgical risks vs the benefits of the procedure and what follows. Your own patient modesty issue should not be included with the risk category and if you insist in putting it there, it should not be a consideration that, by itself, trumps the other risk considerations. ..Maurice.
Anonymous poster from Sunday Oct 23,2011 11:55 am
With all due respect to your privacy concerns,however,I have
never ever heard of an open chest
biopsy.Why?
Lung biopies are done as CAT
scan guided biopsy,low risk,
accurate. Lab results in two days
and the risks,potenial for pneumo
thorax and slight bleeding.
PT
PT, open chest biopsies are still performed particularly when less "invasive" methods for diagnosis are unable to obtain the information needed or the results are ambiguous.
What is missing from the information provided by Anonymous are more medical details. My main point was to emphasize the need to only consider the risks vs benefits of the procedure but not to include modesty in the decision. ..Maurice.
Here are the medical details.
Here are the disease components: Nueromuscular process involving the 12th nerve that include the respiratory muscles needed for breathing,parital temporary diaphragm problems including the inability to "bear down:, pulmonary hypertension, interstitial lung disease, blood clotting factor with absence of any other autoimmune tests, diabetes (because of steroids). History of TIA, osteoporosis.
Bronchoscopy showed no evidence of infection, fungus or virus.
Top neurologist feels this is one rare disease the encompass' all factors.
My position is this. There are only certain drugs that treat inflammation. If I had to choose between stroke or lung disease, I would rather have lung disease. Steroids are causing weight gain, diabetes and bone destruction.
Due to the undiagnosed situation other than varying components, I am unwilling to subject myself to the invasive test, knowing there's a good chance that this is idiopathic and they will never find anything. Additionally, nobody knows how the anesthesia will effect the muscle spasm issue that also effects all muscles but the respiratory ones are the most disturbing. Also, this disease process gets worse in the winter and winter is fast approaching.
Coupling all of this with the other issues, I think I'm making the right decision.
Muscle spasm in the airway cause difficulty inhaling at times and oxygen relieves this symptom in addition to vocal changes.
Maurice, what do you think now?
"only consider the risks vs benefits of the procedure but not to include modesty in the decision. ..Maurice."
Maurice:
I do agree with you. But I would offer two observations.
1. Although the modesty issue shouldn't be included in the "decision," it may be included in choice of caregivers, and your overall satisfaction regarding the procedure. If you can't get accommodated and you insist on it, make it clear that you're going through with the procedure because you value your life and don't believe you have any choice, and that you don't believe your personal values and emotional needs are being respected.
2. If you've had bad modesty experiences before, and this is affecting your feelings, that's one thing. If, however, you haven't experienced the kind of intimate care and exposure you're concerned with -- be open minded. Have high expectations as to how your modesty will be treated. You may end up feeling that your needs were met, even with opposite gender care. If people haven't experienced the kind of hospital care they fear, they don't really know what to expect. It may be more acceptable than you imagines.
I realize my last point won't sit will with some on this blog. If you're completely closed to opposite gender care based upon bad experiences, I understand your position. But for some, although they don't particularly care for the "idea" of opposite gender intimate care -- if they feel and believe their dignity is being respected and they're being treated like a real human being -- the "idea" can become much less important. There can be a great abyss between the ideas we fear and the actual experiences themselves.
To Anonymous 9:53am today--
What you write about your case suggests a multi-system and complicated medical issue or issues.
Hopefully, you had been fully informed by your physicians regarding the reason for the need of the surgical procedure, the full risks and the expected benefit. It does appear that you made a decision based on the risks and benefits and that modesty was not a major contributor to your final decision. ..Maurice.
Yes. My decisions were based on many factors but the most important factor for me is my mental health. Without it, you're nowhere.
Subjected to sexual abuse in a hospital previously that was documented and had consequences for the staff involved, I promised myself that I would never be put in that position again.
While it's easier to arrange for same gender care for a test or a procedure, that simply is not the case when there is an emergency.
I have made it impossible to be treated by opposite gender care by giving a set of instructions to the hospital together with a competency letter and support due to my experience. Should my wishes be ignored, the full extent of the law is on my side.
I'd rather be dead than feel degraded. Maurice, if you have not have the experience with the utmost respect, you do not know what you're talking about.
We have posted a new article on modesty from a woman's perspective.
Take a look and add a comment.
Doug, I think you left out one important part on #2, express your desires and expectations and go in expecting the best. If it doesn't happen address it. If one has concerns and goes into these situations just expecting the best they will likely be severely disappointed. Addressing this issue from a providers perspective is to give the patient what the PROVIDER wants and feels is appropriate, a respectful, professional, opposite gender nurse who explains and uses clinical terms may be sufficient for the provider...doesn't mean it will be for the patient. Tell them up front what is acceptable to you, don't expect them to do it on their own,. left to them, you will get what they feel is appropriate and will be what is cost effective for them..not you...I do feel by and large, ask and you will recieve...alan
You're right, of course, alan. Communication is so important. I've said said that in the past but just assumed it was understood in my post. Let providers know your expectations and then expect the best.
mmodest, you are a gutless fool! You can't let them take advantage of you like that. Everytime a man is too timid to stand up to those perverts it makes them feel more entitled and justified to take advantage of the next guy. There shouldn't even be one woman much less three. What could the other two possibly do to assist? Hold your penis in position or just stand there and gawk? How can these unethical women live with themselves?
Disgusted
I allowed the above commentary by Disgusted to be published as an example of what I don't find as appropriate commentary for this blog.
There are important conflicts and emotional, personal concerns that are being discussed on this blog and civility toward the other visitors should be maintained despite uncivil comments are thought to be better for emphasis. Now, I doubt that mmodest who presented his own comment on Volume #3 is still around to read here, but nevertheless my request for civility is still the rule.
Also, I wonder how "perverts" are made as a label to the female participants when nothing is known about the details of what had upset mmodest. And what does "pervert" mean in health provider context? And how does one support such a label on an individual? Anyway, let's all be civil and clear in our commentaries here. ..Maurice.
1) Allowing observers during military induction physicals
when clearly their presence is not needed. In my view
those allowing observers are in my mind perverts as
well.
2) According the every state nursing board watching a
patient change is considered sexual misconduct.
3) Making sexual comments to a patient or another about
the genitals of a patient is considered sexual misconduct
according to state nursing boards.
4) Leering at a patients genitals or boundary violations that
involves a sexual relationship with a patient is
considered sexual misconduct by state nursing boards.
These are but a few criteria that fall within state nursing
boards guidelines that are considered sexual misconduct.
PT
Dr. Bernstein:
“And what does "pervert" mean in health provider context?”
I know that was probably meant as rhetorical, but if one did choose to answer that..what would they say? Is ‘pervert” in medical context different than any other context? And to what level would one need to see either emotional or sexual gratification in order to satisfy the term?
Most often it is when covert actions become overt, and since people guard their reactions so well (in general) one may never know. Obviously the poster assumes that every woman in healthcare receives some sort of gratification from intimate interactions from male patients. It could be based on a personal experience, or an assumption that women in healthcare are no different than women who are not in healthcare…(male nudity equals female pleasure). So by those basic terms, is that “perverted” or an expected reaction that one must “professionally” hide? (Perhaps with a term such as “gender neutral”?)
Or, perhaps the poster is saying that women gravitate to areas where they can easily satisfy those mental processes. In that case, due solely to the exploitive nature of such intentions and obvious entitlement motives, I might agree with that example.
So, as adults we have to acknowledge that people are attracted to people. Genders are attracted to genders. There is no way to bury that truth in pre-packaged terms. Perhaps the ‘perversion” is the exploitation of the situation, the level of which we feel uncomfortably at the mercy of another gender, and the refusal to give options to mitigate the unwelcome situation.
swf
I agree with swf that women and men who are healthcare providers are as sexually interested as any other man or woman. This does not make any of them a pervert if they behave professionally and do not show actions that are inappropriate to their professional duties or professional standards and specifically not demonstrating any attempt for sexual gratification.
I will state again and again, sexual perverts are not a common denominator of those involved in medical care. Perverts with attempt to sexual gratification are not the reason that some patients feel their modesty concerns are not met.
I am sure they are not met because of system limitations for patient requested caregive gender and because many professionals in medicine have not learned that for some patients their own gender is an issue in terms of modesty concerns..even to the extent of these issues trumping the need for medical or surgical treatment. It is the system and professional ignorance what some patients are facing and what they want. Patients are NOT facing sexual perversion as a common issue. ..Maurice.
My experience did include sexual misconduct. In fact, staff was punished for this behavior, first, with probation and now the doctor involved is no longer affiliated with that hospital.
It is those times when some patients feel such outrage and anger that they sound like "disgusted" when they haven't processed their feelings, gotten help.
Now, perhaps it is understood why some on this blog will not tolerate the presence of anyone of the opposite sex.
I do wish Maurice that you would consider blocking posts that demonize one gender or the other.
This issue is about feelings. Medical personnel as well as patients come in all genders, races and religious backgrounds.
It is very important that research play a part to understanding the motivation of healthcare providers when behaviors such as: public stripping with excess people just standing around, purposeful power abuse, humiliation to make patients submissive as well as the generic cop out "more important things to deal with than patient modesty".
The "cop out" should never be a be acceptable to medical personnel or patients when the psychological foundation of a person is at jeopardy when either real or perceived sexual abuse takes place in the healthcare setting.
Some patients like me ARE or WERE subjected to sexual perversion in a healthcare setting. What then?
belinda
belinda
FROM THE AMERICAN ACADEMY OF PEDIATRICS
“Policy Statement—Protecting Children From Sexual Abuse by Health Care Providers”
http://pediatrics.aappublications.org/content/early/2011/06/23/peds.2011-1244.abstract?rss=1&related-urls=yes&legid=pediatrics;peds.2011-1244v1
I was curious as to anyone’s opinions on this article's content. Of note: statistics, the steps healthcare should take to avoid sexual abuse, chaperoning policies, and educating and empowering staff, parents and patients.
swf
The article is good but these policies should reach out to the entire patient population. You are seeing patients at their most vulnerable. Who doesn't need protection?
SWF, I will say, though, that a deviant staff member will find a way and still work under the "standard of care" and still be deviant. Who can measure an inappropriate glance or leering, how do you measure comments made when nobody else is in the room except the patient and the health care provider.
Systems need to be put into place monitoring staff members based on patient complaints so that there becomes a pattern over time and those deviant who humiliate, who want to abuse their power, will be punished, banished from healthcare and labeled as sex offenders.
belinda
Interesting article but what strikes me most is no mention of psychological damage to the patient.
http://slphealthcareupdate.wordpress.com/2011/03/16/sexual-misconduct-investigation-prompts-medical-board-suspension-of-texas-doctor/
belinda
Dr. Bernstein, I am interested in your thoughts on how I read your post. One of the things that I feel contributes greatly to patients modesty needs being downplayed and therefore ignore. You seemed to acknowledge providers do have the same sexual feelings as anyone else, that I think we would expect, however you seem to indicate it also comes into the medical arena which the vast majority of providers deny. Providers say the fact they do it all the time, the setting, it is clinical, etc all make it different and non-sexual. I as a patient understand it may be less sexual but have always felt they were being less than truthful. I agree if they have these feelings and do everything they can not to show or act on them, they are doing everything they can. However it would make them dishonest or decitful at best, especially when they use it to justify not doing everything they can to address patient modesty. By saying it is not there, when it is, they facilitate the violation. So, to me, having these feelings and claiming the do not exist, they contribute to the wilful violation of patients emotional welbeing. ...am I reading your post correctly?
What I have said in the past on this thread is that first: medical students are taught that patients have physical modesty concerns and to strongly take into consideration patient modesty in performing their physical examinations and to adjust their physical examination procedure accordingly. The students know it and do it, physicians know it and should be doing it, the professional societies know it as they set standards of practice. We also all know that beyond patient modesty, sexual behavior started by the doctor or patient is forbidden.
What I never knew until I started this thread (and I have the feeling that most physicians don't know) is to the extent for which some patients hold their physical modesty when in a medical care context. I mean, to consider that the patient's modesty issues would trump accepted diagnostic and therapeutic procedures, even in potentially life threatening conditions. No patient has ever started a conversation about this and, of course, I have never started such a conversation.
One other factor in medical practice I want to bring up. Yes, there are the those physicians who get into the news and/or are censored or have their licenses revoked by medical boards for unprofessional sexual behavior toward or with patients. But, what about the not rare presence of the seductive patient that all doctors have to face? Does anyone worry about them in relation to medical practice except us teachers of medical students?
The doctor-patient relationship is not a "one way street". Yes, physicians have responsibility to attend to known or suspected physical modesty issues with their patient but patients have the responsibility to communicate with their doctors about these same personal issues and not just "moan and groan" about them on a bioethics or patient modesty blog. ..Maurice.
Maurice,
You seem not to notice that there is a "slippery slope" when it comes to the behavior of medical personnel.
Let's not get off the topic by blaming the patient. Yes, there are patients who seem to be seductive but it's up to the authority figure to squelch it. Patients subjected to deviant behavior (and I do believe that those are the patients who would rather not participate if there modesty issues are not met)are damaged much in the same way that abuse of children occurs.
There is a power differential when it comes to the doctor/patient relationship. The burden is on the physician and their staff to conduct themselves appropriately.
If they cannot, no matter who started it, they should not be practicing.
belinda
Belinda, I fully agree that "The burden is on the physician and their staff to conduct themselves appropriately." I am not blaming the seductive patient (they represent a personality of a patient that the doctor just has to deal with and in response not to lapse into unethical and unprofessional or criminal behavior.
There is always a "slippery slope" for the behavior or actions of healthcare providers from how medical/surgical decisions are made for the patient to how the physician interacts personally with the patient. Getting into a habit of taking chances with casual decision-making or casual, inattentive or borderline appropriate behavior in that interaction with the patient can lead to serious problems. Take a look at the current Dr. Conrad Murray non-modesty context example. ..Maurice.
"SWF, I will say, though, that a deviant staff member will find a way and still work under the "standard of care" and still be deviant."
Belinda: Of course..I agree. For example: All of the coersive techniques traditionally used to foster extreme trust and lull patients into accepting situations that they would ordinarily not accept can ironically make them even more vulnerable to those very situations that they are attempting to protect themselves from.
IF I could manage to actually talk you into letting me do something that you don't want to do,have ethical concerns about, do not want my gender doing on any level, and will feel some embarrassment (and perhaps shame and humiliation) during and after, then I have a very powerful "grooming" tool and my disposal. And if not at the level of grooming, it certainly is manipulative enough to cause some concern.
I worry about making generalizations applied to the vast majority of healthcare providers and their behavior when referring to isolated (and they are isolated ) "deviant staff members". Patients are, in my experience in medicine, not bullied, coerced or manipulated to serve the gains of healthcare providers for developing trust or obtaining financial or sexual gratification from them.
Further, I refuse to believe any significant numbers of healthcare providers are "peeping Toms". If the basic goal of physicians, nurses and other medical or nursing staff or techs is simply to satisfy their own universal sexual needs and interests and not primarily to provide a needed medical service to their patients then there is something critically wrong with the profession of medicine and it requires a complete overhaul.
All the various boards and societies setting strict rules about how to act and how not to act as medical professionals are there to set the limits to those who might want to deviate from the standards but tells nothing about the prevalence within the medical community of those potential or actual "deviants".
All that I have written has nothing to do with the fact that I see there are physical modesty issues which are very important to a host of patients and that the medical system needs further education and changes in the system to satisfy these patient's concerns and needs. ..Maurice.
Personally I think the deviant provider (or for that matter the seductive patient) are so far off the norm and the topic they really aren't relevant to what we are talking about. I have stated before and fully believe that the vast majority of providers are compassionate, caring people or they would not be in the profession. I do not believe they set out to get kicks from exposing patients, further I believe there is an degree of uncomfortable feelings for many providers in these situations both on thier end and for the patient. I do however feel a huge portion of providers are fully aware patients feel uncomfortbale being exposed to opposite gender, perhaps not the degree, but the fact that it exists and by pretending not to know it exists contribute to the problem. Why would providers make a concerted effort to provide female mammographers, offer chaperones, and do other things in certain situations to provide for a patients modesty and ignore them in many others.
My problem with providers are two fold, first by denying they recognize both the sexual aspects of the interaction with patients they validate protocol set by the administration. This is not as much deviant as it is self serving. It makes providers job a lot easier if they ignore or pretend modesty is not an issue for their patients. Deviant, i don't think so, self serving, I am convinced. Out to get kicks, don't think so, gender nuetral...not buying that either....alan
Voyeurism is a very underestimated area of health care. It's also part of human nature. What makes it professional to stand around an ER with someone who is conscience and hysterical not because she's being worked on but because she's being publicly stripped while restrained.
It happens all the time and while disrobing is necessary, it doesn't need to be done in front of everyone. This right of entitlement that the EMT's and police put upon themselves is unacceptable. This kind of scenario can put someone at risk for PTSD and perceived as sexual assault to the victim. It makes me wonder why there aren't protocols put into place for this kind of medical situation.
Having interviewed many patients for the book I'm writing, there was one scenario that really stood out. It was a female patient in bra and panties with a sheet thrown over her legs. She was coming to the doctor to treat a rash she had on her legs. Absent of any rash anywhere else, a group of medical students entered the room. The doctor in charge ordered the patient (with open door due to crowding of medical students in the small space) to remove her bra. The patient was so traumatized that she couldn't respond so the doctor asked one of the female students to assist. She came spilling out of her underthings mortified. This just infuriated her as she already told the doctor that there was no evidence of any rash on her breasts. So...why does this kind of thing happen? How can it be that these people are so insensitive that they can't understand how someone in her position would feel?
I wish someone could explain it. This is only one story. There are hundreds and the theme in all of them is lack of empathy for someone's feelings traumatizing them so they can't react, and then it's all over.
belinda
Yes, sometimes with an interesting physical finding, I have my group of 6 second year med students enter the patient's room and examine the patient but only after the student who had developed a relationship with the patient and found the abnormality obtained the patient's informed consent for the visit and exams, which I then confirm. And the patient is informed that at any time(even if some of the 6 didn't yet examine)if the patient is uncomfortable with continuing the student exams the patient should speak up and we immediately leave. In Belinda's example, the "doctor in charge" was unthinking and unprofessional as a teacher or as a physician.
What is missing in these stories is that the patient is first informed exactly is to be expected and told he or she has every right to order the group to "get out!" and that order will be followed. ..Maurice.
How can anybody know whether someone else is a pervert or not? The fact that I'm an honest businessman doesn't give me the knowledge that all other businessmen are honest. The fact that I'm not racist doesn't give me the knowledge that no other white caucasion men are racist. Nobody can know for a fact what somebody else is thinking or what may or may not be their motives for entering the medical field.
Can anyone know whether or not the woman that inserts a male patient's catheter doesn't go home that night and think about him as she pleasures herself? Apparently many people think that if a nurse doesn't smile from ear to ear, turn cartwheels or take pictures when she sees a naked man (or boy) then she isn't "getting off" at the sight. Almost everyone has the ability to keep a straight face while getting off or fantasizing.
How or when can we determine that someone is "gender neutral"? Does a few months at the community college make someone gender neutral? Is it when someone changes into scrubs that magically turns them gender neutral? Or could it be when they sign a document confirming that they are gender neutral?
I personally know several female nurses that I know are perverts and have been most of their lives. My niece admitted to me that she's taking nursing classes in high school because she knows she'll be able to be around naked men. So I know for a fact that many (and I suspect the majority) of nurses are perverts.
For those that spend a fortune as well as eight or more years in medical school to be doctors I tend to believe they are usually more serious about a medical career and aren't in it just for the nudity and exploitation. But when the only requirement to be a CNA is a few months of classes I suspect many people will make that sacrifice to make their sexual fanatasies come true. Though I do have my suspicions about male gynocologists and female Urologists.
Maurice,
While I do appreciate your comment, what I didn't mention is that the patient was not informed anyone would be in the room and she had no idea what to expect. Based on a patient's point of view, there's every reason for her to be traumatized by this experience because trauma is always unexpected.
My own experience has shown me that when trauma occurs nobody has explained. What happens when patients are "punished" for seemingly uncooperative behavior when what's really happening is that the patient is overwhelm by traumatic experience as in unexpected surgery, given commands and cannot respond. It's not because they don't want to, it's because they cannot.
I agree with Alan 100%. Although I imagine there are isolated cases where a medical provider acted with "deviant" motives, I think the vast majority of interactions are standard and clinical in nature. In fact, my concerns with physical modesty in a medical setting have never been because of a fear of sexual, deviant behavior. It has always been more of a need for comfort, reduction of a feeling of vulnerability and, hopefully, a lessening of embarrassment. These factors are more of an issue with me; I never really have thought of the whole interaction as sexual in any way. And I do agree with Alan: medical providers are most surely aware of patient's concerns with exposure, especially to opposite gender, but they deal with it in a self-serving way. They most likely avoid the issue by not bringing it up, stessing the gender neutral stance and/or assuming that the patient is accepting of whatever care they are receiving and whoever is providing it. The ultimate solution to this would be for both sides to speak up and I would expect that the larger burden of that is going to fall on the patient. Jean
Jean,
While I agree with your point of view that most practicing medical professionals are not sexually deviant, please don't dismiss the issue of the damage caused because some of them are.
I have mentioned before that there is elder care abuse, abuse of the disabled, and institutional abuse of all kinds in mental hospitals, and yes, regular hospitals too.
What happens to the patients who are subjected? This is not a subject that is out of main stream as you might think.
As someone who was victimized in this way, it changes the world as we see it, loss of control, not feeling safe. Same gender care for those of us is a mandate.
For all of you who feel these cases are isolated, I think you might want to do a little research. You might be surprised with the results.
belinda
Just to be clear, my post never said that most healthcare providers
were "deviant staff members". It simply said the medical arena provides a unique opportunity for those who are, with some pre-packaged coersion techniques that allow some to fly under the radar for so long.
Somewhere there is a middle ground in between patients who allow disrespectful behavior and providers who willingly participate in it. Accountability. Patients need to know that they can say "no" (and do it!), and providers need to be humble and open minded enough to accept it. Humiliation should never be accepted as a "fair trade for care": nor should it be just an accepted daily part of getting your job done.
It seems we are always missing that one link in the chain of communication.
swf
Swf, I agree with you too. However, it's important that when these things happen, they sometimes happen so fast. The behavior is sometimes so outrageous that patients are overwhelmed and don't have a chance to process the information. Their brains are in slow motion, and everyone else is in real time.
Once the patient understands what's happening and can react, it's too late to say no. It's too late to say anything and the experience is over.
The damage is irreversible and when there's sexual deviance, done against a patient's will (if they weren't asked, it was) then, this behavior turns into sexual assault.
Some dissociate completely and some remember everything in vivid detail, then dissociate.
Until the medical community starts keeping track of complaints on individuals, there is no accountability, no responsibility and these people are still practicing.
Swf, one of the things the research says is that deviants gravitate to healthcare because of easy access and patient vulnerability. It's a very big problem and the medical industry and done nothing to institute protocols that protect patients.
One form of protection is to give us what we need because we will refuse if we don't get it.
Maurice, I wish there was something more that I could say that would make you understand that once you play with someone's mental health, it becomes the most important part of the self above and beyond any physical condition.
belinda
Dr. Berstein, first once again I do appreciate the opportunity you and Dr. Sherman have provided. 2nd there have been positive steps as a result of these blogs, I have taken a more active role that has helped me avoid further problems and SWF and I are in the first stages of looking at a web site and other active efforts to begin addressing this. I do think one thing that has been left out of this discussion of who has the responsiblity to address this issue patient or provider. There is a history of providers pressuring patients to comply with what they are offerred. Men were made to feel they were sexist if the didn't want a female Dr or didn't want a female present during exposure. Women for many years weren't even given an option. So while it is to the patients own benefit to stand up for themselves, I feel it is not right to let the provider off the hook, on top of ignoring what they have to realize, historically they have pushed this agenda. That said, I am taking care of myself rather than count on providers to do what they should be doing. Lowers my opinion of providers, but raises my experience...alan
Alan, patients, who have the mental capacity, should always be responsible for their own physical health but also their emotional or mental health and not depend only on medical professionals to take over all that responsibility. I fully agree and am pleased to hear about your plans with swf to provide a mechanism for further advocacy of the patient modesty issue perhaps even beyond advising each patient to "speak up" individually to their medical providers regarding their privacy needs. But to also go on and attempt to improve the medical system with public and professional education of the issue and demands with suggestions for change. ..Maurice.
Maurice, I am delighted to hear that you feel it is up to the patient to provide for both their physical and mental health. Everything I've done is to take care of both, pushing the envelope for my own health care and pushing the envelope to achieve what I need. The mental health issue will always outweigh the physical one.
If doctors are treating the whole person and there is evidence that state of mind has a strong part in healing, don't you think it would behoove the medical profession to get involved with this modesty issue, protecting patients, instead of giving us a hard time?
The hard time is caused by many different issues that need their own research topic.
Once I was scheduled to have an intimate procedure and a male anesthesiologist came into my room after I pre-arranged for a female team. He was intimidating, angry and told me that we might to reschedule for another day.
My response was that it was okay to reschedule and he stomped out of the room without any regard to why I made the request.
If "to do no harm" is part of the Hippocratic Oath, then why don't these issues take priority like any other?
belinda
Let's consider what the medical community takes seriously. They screen millions and millions of people that they might help percentages of them. The MAJORITY of people will not get breast, prostate, or colon cancer: but a significant amount will. And when those percentages are us, we are thankful for that consideration. Serious business,those percentages.
The MAJORITY of people will not be abused in the medical system, but a significant amount will. The MAJORITY of people may not feel taken advantages of, humiliated, or left feeling emotionaly raw from the nonchalance of ethical breaches, but a significant amount will.
Serious business those percentages? Not so much.
Until we tell them this is a problem that we will no longer brush under the rug, then it isn't really a "problem". Our issues do not become their issues until we make them their issues.
So what are these "protocals" that we want? How can we force "accountability'? What are the solid solutions and how can we put them into place? Yes, let's empower the patient. Yes, let's tell the medical community that we want these isssues fixed. But it's not going to happen until we become "serious business".
Dr. Bernstein, while I agree with you in principle, its just not that simple. When you look at the dynamics of the patient provider relationship, what are some of the basic principles, you are to follow the orders of the Dr., take the medicine as prescribed, follow their instructions, if they want additional testing, if they say quit smoking or loose wieght, are we to make our own decisions or expected to follow providers instructions? If I were to question the orders of the Dr's you know, would the response be "Good for you, taking control of your health" or indignation at questioning their advice. Historically questioning directives from providers has been discouraged at nearly every level. To qoute Bob Dylan, "the tines they are a changing", but they haven't changed yet. If modesty is important to a patient they have to take control, but a relevant question is Should they have to? Isn't patient welbeing, physical and emotional what we are paying for, and paying for at a rate that is at the top of the world? Do you have to question the kid at McDonalds to make sure he is properly preparing the dollar meal or see that the cooks it properly? Do you expect the kid making minimum wage to give you the service you expect or do you feel you have to tell him to be polite and thank you. So why should we have to make sure the people we are paying 10's of 1,000's of dollars that we want to be treated with the respect WE want, not what THEY want. If the kids at McD's says hey dude, what do you want? because HE felt it was proper, would it be OK. Sorry Dr. Bernstein, I respectfully disagree, while this was tongue in check, and I realize I have to take charge to protect my modesty, I still question should I have to, I do not believe providers do not have a clue about patient modesty, I just believe they choose not to recognize it...alan
Alan, I think that most doctors consider "now a days" the need to recognize that the patients are now autonomous and not subjects of the paternalistic advice or orders of their physicians. Of course, it is imperative that physicians do a good job to educate the patient and family with the medical facts and what is known about therapy but really the compliance of patients to follow professional advice can only be assured by the patients themselves. In fact, the previous use by healthcare providers describing patients with the negative term "non-compliant" is now sort of frowned upon.
I think this whole issue of providing patient desired gender by the medical system is an economic and logistic issue that needs resolution by system-wide attention and cannot be solved in isolated individual practices.
Believe it or not, as I have previously written, the modesty concerns as described in these years long thread volumes is I suspect, as it was to me, unknown to the vast majority of medical practitioners. I am sure that if more doctors became aware, this would lead to changes desired by those writing here. That's why any propagation of your advocacy issues to the rest of the public and to the medical system is essential to promote change. ..Maurice.
"Believe it or not, as I have previously written, the modesty concerns as described in these years long thread volumes is I suspect, as it was to me, unknown to the vast majority of medical practitioners."
Maurice -- I ask this respectfully. It's not a rhetorical question. Why do you think your above comment is true for you and other physicians? When you say "unknown" to you -- do you mean you weren't taught about it, and/or it was never discussed among your peers, and/or you never really noticed patient discomfort, and/or you were taught directly or indirectly that gender didn't matter, and/or your perception was that it really didn't matter to patients, and/or your focus was on other medical issues related to the patient, or...?
You may have covered this in past posts, but I don't recall reading your thoughts on this.
Hi Maurice,
I was disappointed that you didn't respond to my post asking why the issues don't seem important even though the links between physical and mental health are paramount. Another person posted these thoughts as well.
What we are asking if that doctors because they are human, have had thoughts even from their own experiences as patients or from a general frame of reference.
I don't believe that doctors and other medical personnel are oblivious. I believe that that's what they want you to think.
Someone should stand up and we would like that person to be you...to stand with us demanding those changes. Seeing harm the status quo has caused, why wouldn't you?
belinda
Just an intersting side note, I was meeting with some hospital admin, and some other people about setting up a scholarship for nursing, I told them I wanted a preference for males entering in the field. I had to keep refocusing the issue from generic to preference for males, finally one of the hospital admin. (female) said I don't know if I feel comfortable with that, it might be discriminatory, one other said well we have the X scholarship which is for females entering school for being a physician, without blinking she said thats different, females are protected...she also made the comment the ratio of females to males in med school is 55-45. Not wanting to return to the war of the sexes but I thought it was an interesting exchange...alan
Doug, we were taught and we teach patient modesty but only in the context of care for unnecessary exposure of the patient and when the patient was to be exposed to inform the patient and ask the patient regarding their comfort. Also taught is the importance to avoid behavior which might be interpreted as sexual acts. The issue of gender selection and patients avoiding a medically necessary procedure because of modesty was unknown by me and I suspect most other physicians. This was simply because the issues were not brought to my attention by the patients. The matter of the gender of the professional was only taught in terms of the need to provide a chaperone, specifically in the case of a male physician performing a pelvic exam. Now, I know better because of this thread.
Belinda, I and I am sure other physicians are not ignorant of physical modesty in certain situations because I am sure most of us, if not naturists, care about our physical privacy in various situations. But, speaking for myself, I still say, repeatedly, that I never thought modesty would trump medically essential procedures or treatment. I never thought that modesty issues which develop in those procedures or treatment would lead to post-traumatic stress mental illness.
With regard to my standing up for the views of virtually all writing to this thread, I tried personally to get one hospital administrator to participate here to no avail, though we did get spontaneously a series of comments from apparently a hospital official in the recent past. I am about to make contact with a local hospital official involved in "service excellence" regarding the issues here. Finally, I myself wrote an article to the AMA News a few years ago and around the first of this year, Doug and I wrote another article to the same publication. We are trying. ..Maurice.
Thank you Maurice for your comments.
I will tell you that I never thought about this issue until something that involved sexual deviance happened to me; never asked the gender of the provider no matter what the bodily exposure.
The example that I gave regarding the woman with the group of students didn't result in PTSD. However, if you consider that future avoidance of medical care might be the only symptom, it is one of the symptons that a patient, by itself, might not recognize.
What I am saying and is paramount to this discussion, is that when patients are not informed, or given the time to respond and they are exposed without knowing in front of groups of people, this, by itself is enough to make some vulernable to PTSD.
What happened to me and is the subject of a book equated with psychological torture in a medical setting involving deviant staff members. It's complicated and took years to process and I'm one of the lucky ones.
You would not, nor would anyone else develop PTSD from a normal medical situation where you are informed. Ten different people could be subjected to the same stimulus and only some of them might develop PTSD. However, if someone knew "what buttons to push" everyone would develop this problem as it is a protective mechanism to keep you safe (PTSD).
How could someone like me put all their trust in "the system" when it's almost always likely to fail me due in part to the medical practices of today.
What I take issue with, is that some of these situations would likely upset anyone and yet the people causing the problem have no clue. It's beyond my understanding. If those are acting unprofessionally, that should examined too. It's all too common and disgraceful that the medical industry want to sweep it under the rug, so I thank you for what you are doing.
belinda
belinda:
Respectfully...you admit that you " never thought about this issue until something that involved sexual deviance happened" and "never asked the gender of the provider no matter what the bodily exposure.", yet you find it hard to believe that the medical community does not think of gender either. So I would wonder, sans the abuse, would Dr. Bernstein ever find himself in a position to be justifing himself and how he believes?
This push for modesty and respect is fairly new, and part of it is because many patients are passive participants. I'm not saying the system is not flawed and shouldn't have been fixed long ago, but we can't get what we want if we never asked for it.
Honestly, I think we ALL think about this issue to some degree, but either ignore it or have faith that it will not come to our door. The question is: who will fight harder? Those who want to change it, or those who want it to stay the same?
What will be the most difficult is to fight for those who are fine with the system until something bad happens to them.
belinda: how do you think we should approach that?
swf
swf, Your comments are valid and I'm glad you asked this question.
Yes, I did say those things. However, I wonder how I would have felt about this issue if something happened to me that was less egregious but none the less humiliating if I might not have given this issue a thought.
Those things happen all the time in healthcare. I fortunately, up to that period and even then (as this happened prior giving birth).
What I was saying is that we have certain social norms that are completely broken when entering the healthcare system. One of those things is going to the bathroom in front of others or having someone bathe them, etc. These things are part of our normal daily lives that we become more aware of as our situation becomes more socially abnormal.
Many of the incidents that occur in healthcare, you would think would be thought of because the caregivers are human, as we. Examples of that kind of treatment would include being stripped in front of a large audience with "gawkers" present while you are conscience, putting patients on "display" in front of a large group of people as was (and perhaps still is) in teaching hospitals. They consent to having people present but not told they will be completely disrobed. This happens to the disable, and particularly to disabled women.
You would think that with all the wonderful steps we have made in medicine, that the medical community would have put some effort into the psychological feeling of safety and comfort for those disadvantaged.
Another side to this issue is punitive. I can only tell you what I have learned from other patients and what I have been told "off the record" by medical employees and that is to punish patients for being uncooperative, they are purposefully humiliated.
This treatment is spoken about all the time with regard to the elderly and the disabled and it goes beyond that to our prison system and mainstream hospital care.
This is the area where I take offense. It is the foundation of the patient bill of rights and yet the medical community ignores it. Dignity is one of the first things mentioned. What does that mean and how does that project to different patients.
This is the reason it is paramount to ask patients what they need and why and should become part of the consent process in every hospital.
belinda
Maurice said
"Further,I refuse to believe any significant number
of healthcare providers are peeping toms."
Do you define healthcare providers as all those that
provide direct patient care,ie physicians,nurses,
respiratory techs,x-ray techs and so forth?
What do you define as significant numbers? I believe
the numbers are significant.
Alan
I attended Indiana University and for
awhile worked at some of the local hospitals there
and certainly saw that mentality that you speak of.
PT
During research I interviewed a Director of Risk Management at a big city hospital. I was told that 40% of the complaints were from complaints of this sort.
I will be providing links to some of the research areas.
Whoever doubts that this kind of thing goes on do a little reading into the purposeful and willful humiliation of senior citizens in nursing homes, etc.
Belinda
This is an article published in the NY times. Most of my research is in the form of PDF files and will give those websites when correlated. I chose to post this article because of the nature of it's content.
Maurice, perhaps you can shed light on why a medical professional would behave in such a manner. This is not uncommon and illustrates an abuse of power, willful humiliation of the patient.
It is almost unbelievable for us to assume that this doctor did not know what he's doing. This woman was essentially publicly stripped, was not asked for consent. Public stripping is the first act of torture used to humiliate and degrade people. There was no need to strip this woman, no medical advantage to her condition. At the least, she was treated cruelly and disrespectfully.
While the intent might not have been sexual, it was a cruel and degrading thing to do to a patient and there are more examples of this behavior that is part of what is swept under the rug.
http://www.nytimes.com/2005/08/16/health/16dignity.html?pagewanted=all
belinda
My article on why men avoid doctors has been republished on Kevin MD blog.
Please take a look and add any comments.
Belinda, all I can say is that some doctors teaching students or interns or residents are thoughtless. The care and attention that those of us teaching in the first two years of medical school see our teaching of humanistic behavior withered in the "hidden curriculum" of "education" in the later years. I cannot deny that such unthinking behavior on the part of doctors exists. It all has to do with the physician's assumption that the goal of such ward rounds is for teaching primarily and the patient is by some default, even without asking, going to be a willing object to this teaching. What these physicians don't recognize is that it is the appropriate treatment of the patient, both physically and emotionally that is the main goal in the ward rounds and that the teaching is a fortuitous secondary benefit to the session. Unfortunately, because of the supervisory and dictatorial power of the attending physician teacher, the group of learners may be afraid to attack the physician's behavior in defense of that otherwise defenseless patient. ..Maurice.
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